Epidemiology, Incidence of Infection, and Antibiotic Use in Pediatric Traumatic Ear Lacerations

The management and use of antibiotics in pediatric ear lacerations lacks standardization. This study sought to provide a comprehensive review of these injuries and assess the impact of administering perioperative antibiotics on the incidence of infections after repair.

Retrospective review of all pediatric ear lacerations treated at our institution's emergency department (ED) between 1998 and 2024.

A total of 246 patients (177 boys) were included. Patients aged 0-6 years were most affected (n = 117, 47.6%), with the peak between 2-5 years old (n = 78, 31.7%). Most lacerations were superficial (n = 145, 58.9%), followed by intermediate (n = 62, 25.2%), full thickness (n = 34, 13.9%), and split earlobe defects (n = 5, 2%). Most of the patients (n = 110, 54.7%) were managed by emergency medicine providers. Plastic and reconstructive surgery (n = 34, 16.9%) and otorhinolaryngology (n = 32, 15.9%) consultations were obtained when the lacerations affected cartilage (P < 0.001). Surgical repair included primary closure in 203 (82.5%), with 179 (88.2%) performed under local/topical anesthesia in the ED. Of patients with cartilage lacerations (n = 61), 48 had cartilage repair. Eight patients had preoperative intravenous antibiotics, while 105 (42.7%) received postoperative prophylactic oral antibiotics. Among those with intermediate and full-thickness injuries (n = 96), 67.7% were discharged on prophylactic oral antibiotics. Only 1 case of surgical site infection occurred in a patient with a superficial laceration.

Pediatric ear lacerations mostly affect boys aged 2-5 years and are usually repaired under local anesthesia in the ED. The incidence of infection is low, and the routine prescription of prophylactic oral antibiotics appears to have a limited impact on the overall incidence of surgical site infection. Further studies are needed to validate these findings.