Traumatic lacerations: what are the risks for infection and has the ‘golden period’ of laceration care disappeared?

Abstract

Objective To determine risk factors associated with infection and traumatic lacerations and to see if a relationship exists between infection and time to wound closure after injury. Methods Consecutive patients presenting with traumatic lacerations at three diverse emergency departments were prospectively enrolled and 27 variables were collected at the time of treatment. Patients were followed for 30 days to determine the development of a wound infection and desire for scar revision. Results 2663 patients completed follow-up and 69 (2.6%, 95% CI 2.0% to 3.3%) developed infection. Infected wounds were more likely to receive a worse cosmetic rating and more likely to be considered for scar revision (RR 2.6, 95% CI 1.7 to 3.9). People with diabetes (RR 2.70, 95% CI 1.1 to 6.5), lower extremity lacerations (RR 4.1, 95% CI 2.5 to 6.8), contaminated lacerations (RR 2.0, 95% CI 1.2 to 3.4) and lacerations greater than 5 cm (RR 2.9, 95% CI 1.6 to 5.2) were more likely to develop an infection. There were no differences in the infection rates for lacerations closed before 3% (95% CI 2.3% to 3.8%) or after 1.2% (95% CI 0.03% to 6.4%) 12 h. Conclusions Diabetes, wound contamination, length greater than 5 cm and location on the lower extremity are important risk factors for wound infection. Time from injury to wound closure is not as important as previously thought. Improvements in irrigation and decontamination over the past 30 years may have led to this change in outcome.

Risk factors for health care–associated infection in hospitalized adults: Systematic review and meta-analysis

“…In this SR, 40 of the included studies were cohort studies, among which the most frequently observed RFs were age, [12][13][14][15][16][17][18][19] diabetes mellitus (DM), 15,[17][18][19][20][21] chronic obstructive pulmonary disease 13,15,19,22 and type of diagnosis (gastrointestinal, cardiovascular or trauma), [14][15][16]23 body mass index, 13,19,24 compromised immune system, 23,25,26 male sex, 20,22,27 female sex, 15,18 weight loss, 13,15 smoking, 13,15 temperature ≥38.5°C or ≤36.0°C, 28,29 medicated hypertension, 15,26 serum albumin levels (<3.0 g/dL), 12,30 and anemia. 16,24 In contrast, several studies observed a lower proportion of other intrinsic RFs ( Supplementary Table S1).…”

“…DM was identified in 2 studies 20,21 that have demonstrated statistically significant differences. An Italian epidemiologic surveillance program in 18 ICUs with a total sample of 5,561 patients concluded that DM is associated with twice the risk of developing an abdominal surgery-related infection and 4 times the risk of HAIs in the bloodstream.…”

Randomized, controlled trial of povidone-iodine to reduce simple traumatic wound infections in the emergency department

“…Besides, previous studies suggested that wounds on head and neck were less commonly associated with infection development than other locations. In this regard, the incidence of infection estimated 1% to 2% in head and neck, whereas legs and lower extremities were as high is 23% (34)(35)(36)(37). Since these sites are considered to be more infection-prone (20), it is therefore important to consider the site of wounds once deciding to choose cleansing agents with better efficacy and lower adverse effects.…”

Seeing the forest for the trees: Institutional environment impacts on reimbursement processes and healthcare operations

“…Many individuals across the globe experience a laceration—a wound from splitting or tearing of skin. Over six million laceration treatments occur in U.S. inpatient emergency departments each year at a cost of well over $3 billion (Quinn et al., 2014). Fig.…”