Hollander J E, Singer A J, Valentine S
Department of Emergency Medicine, University Medical Center, State University of New York at Stony Brook 11794-8350, USA.
Pediatr Emerg Care. 1998 Feb;14(1):15-8. doi: 10.1097/00006565-199802000-00004.
We compared emergency physician's wound care practices in young children (< or = 5 years) and adults (> or = 18 years) and the effect of these different practices on infection rate and cosmetic appearance.
Cross sectional study.
University hospital emergency department that rarely uses conscious sedation.
Consecutive patients who presented with lacerations over a four-year period.
Structured closed question data sheets that assessed 26 separate wound characteristics were prospectively completed at initial presentation and at suture removal. Infection and cosmetic appearance were assessed with previously validated scales. chi(2) tests were used for categorical variables, t tests for continuous variables.
We evaluated 3624 patients: 853 children and 2771 adults. Wounds in children were more likely to be on the head (86 vs 38%, P < 0.01); linear (88 vs 77%, P < 0.01); shorter (1.9 vs 3.0 cm, P < 0.01); less often contaminated (4 vs 11%, P < 0.01); and more commonly caused by blunt injury (69 vs 37%, P < 0.01). With respect to treatment, lacerations in children were less likely to receive irrigation (53 vs 77%; P < 0.001) but slightly more likely to be scrubbed (50 vs 45%, P = 0.01). The two groups received similar numbers of sutures per centimeter (2.6 vs 2.3). Using logistic regression, the differences in irrigation were not explained by the differences in laceration characteristics. Despite less frequent irrigation, children had lower wound infection rates (2.1 vs 4.1%; P = 0.004) and better cosmetic appearances (optimal score, 75 vs 64%, P = 0.0003).
Emergency physicians at our institution are less likely to irrigate lacerations in children than adults; however, children had a lower infection rate and more favorable cosmetic outcome.
我们比较了急诊医生对年幼儿童（≤5岁）和成年人（≥18岁）伤口的处理方法，以及这些不同处理方法对感染率和外观的影响。
横断面研究。
很少使用清醒镇静的大学医院急诊科。
连续四年期间出现裂伤的患者。
在初次就诊和拆线时前瞻性地完成评估26项不同伤口特征的结构化封闭式问题数据表。使用先前验证的量表评估感染和外观。分类变量采用卡方检验，连续变量采用t检验。
我们评估了3624例患者：853名儿童和2771名成年人。儿童的伤口更可能位于头部（86%对38%，P<0.01）；呈线性（88%对77%，P<0.01）；较短（1.9厘米对3.0厘米，P<0.01）；污染较少（4%对11%，P<0.01）；更常见由钝器伤所致（69%对37%，P<0.01）。关于治疗，儿童裂伤接受冲洗的可能性较小（53%对77%；P<0.001），但擦洗的可能性略高（50%对45%，P=0.01）。两组每厘米缝合针数相似（2.6对2.3）。使用逻辑回归分析，冲洗的差异无法用裂伤特征的差异来解释。尽管冲洗频率较低，但儿童的伤口感染率较低（2.1%对4.1%；P=0.004），外观更好（最佳评分，75%对64%，P=0.0003）。
我们机构的急诊医生对儿童裂伤进行冲洗的可能性低于成年人；然而，儿童的感染率较低，外观效果更佳。
