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Scalp Staples Placed in a Pediatric Emergency Department: Feasibility and Benefits of Home Removal
Bruce J Quinn1, Andrea Mancinelli2, Kathleen Rooney-Otero3
1From the Holtz Children's Hospital at Jackson Memorial Hospital, Miami, FL.
Insights
Caregivers can successfully remove their child's scalp staples at home after training in the pediatric emergency department (PED). This method avoids clinic visits, saving time and money for families.
Area of Science:
- Pediatric Emergency Medicine
- Wound Care
- Surgical Procedures
Background:
- Scalp lacerations are common in children.
- Skin staples offer rapid closure in pediatric emergency departments (PEDs).
- Staple removal typically requires a follow-up clinic visit.
Purpose of the Study:
- To evaluate caregiver ability to safely remove pediatric scalp staples at home.
- To assess the feasibility of home-based staple removal to reduce healthcare costs and parental burden.
- To determine patient and parent satisfaction with home staple removal.
Main Methods:
- Prospective study of 30 children over 4 years old with scalp lacerations closed by staples.
- Caregivers received training and a take-home kit for staple removal.
- Follow-up surveys assessed success rates, costs, and satisfaction.
Main Results:
- 93% of caregivers successfully removed all staples at home.
- Caregivers preferred home removal, reporting high comfort levels.
- Home removal avoided significant costs related to lost wages, transportation, and missed school days.
Conclusions:
- Caregiver-led home removal of pediatric scalp staples is safe and effective.
- Teaching caregivers staple removal in the PED reduces healthcare utilization and patient/parent burden.
- Home staple removal enhances patient and parent satisfaction and offers significant cost benefits.
Objectives:
Scalp lacerations are a common occurrence in the pediatric population. A preferred method of closure in a busy pediatric emergency department (PED) is skin staples, because of their ease of use and rapid application. However, using skin staples also demands that the child have a follow-up visit for their removal. This study examines whether caregivers can be taught how to safely remove their child's skin staples at home, obviating the need for a return clinic visit and its associated costs.
Methods:
This is a prospective, convenience study of 30 children older than 4 years presenting with a scalp laceration that the attending physician chose to close with skin staples. Caregivers of enrolled children completed an initial survey and received training in skin staple removal in the PED. Upon discharge, caregivers were given the staple removal device and specific instructions indicating the date for staple removal and how to access an online video reviewing proper staple removal technique. Caregivers were contacted after anticipated staple removal for completion of a follow-up survey. We recorded caregiver success rate at staple removal and measured potential benefits with regard to lost wages, transportation costs, and missed school time. Data were analyzed using descriptive statistics.
Results:
Twenty-eight (93%) of 30 enrolled caregivers were successful in completely removing their child's staples; one caregiver did not attempt removal and another was lost to follow-up. Twenty-five caregivers (83%) completed follow-up surveys. All caregivers reported that if given a future choice, they would prefer to remove their child's staples at home rather than return to a clinic and all said that they would be "very comfortable" if they needed to remove staples again in the future. Sixty-four percent of caregivers estimated that it would have taken greater than 2 hours to attend a clinic for staple removal. Thirty-two percent of caregivers would have lost greater than US $100 in wages. Eighty-eight percent of children would have missed school time, with 46% having to miss an entire school day.
Conclusions:
Caregivers who were taught how to remove their child's scalp staples in the PED before discharge were highly successful at home. Ninety-three percent of enrolled patients had their staples completely removed and no complications were reported. Benefits included avoiding lost wages, lost time attending a follow-up clinic, and lost time from school. Staple removal is a simple technique that can easily be taught to caregivers in a matter of minutes and lead to greater patient and parent satisfaction.
