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Racial Equity in Facial Laceration Repair: Evaluating a Pediatric Plastic Surgery Consult Guideline
David Mills1, Isabella G Steidley2, Elizabeth M Waltman3
1Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
American Journal of Preventive Medicine
|April 12, 2026
Summary
Racial and ethnic inequities in plastic surgery consultations for pediatric facial lacerations were identified. Implementation of a clinical practice guideline resolved these disparities, demonstrating its potential to reduce health inequities.
Area of Science:
- Pediatric Emergency Medicine
- Plastic Surgery Outcomes
- Health Equity Research
Background:
- Facial lacerations in children raise concerns about cosmetic outcomes, prompting potential plastic surgery consultations.
- Access to specialized care for pediatric facial lacerations may be inequitably distributed across racial and ethnic groups.
- This study aimed to investigate racial and ethnic disparities in plastic surgery consultation rates for pediatric facial laceration repair.
Purpose of the Study:
- To evaluate the existence of racial and ethnic inequities in plastic surgery consultation rates for pediatric facial laceration repair.
- To assess the impact of a clinical practice guideline (CPG) on these consultation rates.
- To determine if guideline implementation could mitigate identified health disparities.
Main Methods:
- A retrospective cross-sectional study was conducted at a children's hospital from 2016 to 2022.
- Included were 6,938 pediatric patients (0-18 years) undergoing facial laceration repair in the emergency department.
- A CPG for plastic surgery consultation was implemented in March 2020 to standardize care.
Main Results:
- Prior to CPG implementation, non-Hispanic Black patients had significantly lower odds of plastic surgery repair compared to non-Hispanic White patients (aOR 0.18).
- Post-CPG implementation, consultation rates were: Hispanic 5.9%, non-Hispanic Black 7.3%, and non-Hispanic White 11.9%.
- Following CPG implementation, no statistically significant difference in consultation rates was detected between racial/ethnic groups (aOR 0.63).
Conclusions:
- The study identified previously unrecognized health inequities in plastic surgery consultations for pediatric facial lacerations.
- Implementation of a standardized consultation guideline effectively resolved these disparities.
- Guideline implementation demonstrated a potential secondary benefit in reducing health inequities for this patient population.
