Risk Factors for Infection in Patients with Traumatic Lacerations

Abstract

Abstract. Background: Most of our knowledge of laceration management comes from studies in animal models or patients with closure of sterile postoperative surgical incisions. Traumatic laceration management has not been well studied. Objective: To determine which characteristics of traumatic lacerations were associated with the development of wound infection. Methods: A cross-sectional study of consecutive patients with traumatic lacerations repaired over a four-year period was conducted. Structured closedquestion data sheets were prospectively completed at the time of laceration repair and suture removal. Infection was determined at the time of suture removal. Multivariate modeling was used to determine the adjusted odds ratio (OR) of infection. Results: Five thousand five hundred twenty-one patients were enrolled; 195 patients developed an infection (3.5%). An increased likelihood of wound infection was associated with age (adjusted OR per year, 1.01; 95% CI = 1.0 to 1.02); history of diabetes mellitus (adjusted OR 6.7; 95% CI = 1.7 to 26.4); laceration width (adjusted OR 1.05 per mm; 95% CI = 1.02 to 1.08); and presence of foreign body (adjusted OR 2.6; 95% CI = 1.3 to 5.2). Laceration location on the head/neck was associated with a decreased risk of infection (adjusted OR 0.28; 95% CI = 0.18 to 0.45). Conclusions: Both patient and wound characteristics of traumatic lacerations have an influence on the likelihood of infection. This knowledge may be valuable for determining whether various methods of wound cleansing, debridement, and repair can improve the outcome of patients with traumatic lacerations. Key words: wounds; lacerations; sutures; infection; cosmetic appearance; outcomes. ACADEMIC EMERGENCY MEDICINE 2001; 8:716-720 L ACERATIONS and open wounds are the third most commonly encountered problems in the emergency department (ED), accounting for 8% of the 95 million annual ED visits in the United States.1 The ultimate goals of wound management are to avoid infection and achieve a functional and cosmetically acceptable scar.2,3 Although death and life-threatening morbidity from traumatic lacerations are rare, improper management may lead to an increased likelihood of wound infection and a decreased likelihood of achieving a cosmetically appealing outcome. These largely avoidable outcomes may result in significant patient inconvenience or long-term psychological sequelae.Most studies of wound care have focused on postoperative infection rate.3-9 Current practices are generally derived empirically, based on obser- vations in animal models or extrapolation from data derived in the operating room. Data derived from the animal laboratory usually result from a model where between 10 5 and 10 9 bacterial colonies are inoculated into surgical incisions. [10][11][12][13][14][15] Extrapolation to the clinical setting where most lacerations may have less than 10 2 bacterial colonies is unclear. 16,17 Likewise, extrapolation from the setting of elective operative incisions to the ED setting is also of unclear si...

The Effects of Oral Antibiotics on Infection Prophylaxis in Traumatic Wounds

“…The factors affecting infection development are the localization of the wound, duration, depth, configuration and contamination characteristics. [1,2] The presence of a foreign body or visible damp areas. In wounds contaminated with human or animal excretion, infection risk is high despite treatment.…”

“…[10] For the wounds closed at the emergency department, the infection rate is approximately 3-5%. [1] There is no conclusive evidence showing that antibiotic prophylaxis prevents wound infection in patients whose wounds are closed at the emergency department. [1,10,11] Common practice is to start antibiotic prophylaxis after treatment at the emergency department on the traumatic wounds with suspected infection.…”

“…[1,2] Since more devitalized tissue is created in crush wounds inflicted by blunt objects, the risk of infection increases compared to those in inflicted with sharp objects. Although bacterial inoculation development and its amount are related to the time that passes between injury and repair, [1,3] the relationship between wound closure duration and clinical infection is not clear.…”

“…[1,2] Since more devitalized tissue is created in crush wounds inflicted by blunt objects, the risk of infection increases compared to those in inflicted with sharp objects. Although bacterial inoculation development and its amount are related to the time that passes between injury and repair, [1,3] the relationship between wound closure duration and clinical infection is not clear. [4][5][6] The etiology, location, degree of contamination risk factors of the host and the importance of cosmetic look of the wound are important in determining primary or secondary closure.…”

“…Therefore; anatomic localization is important to be able to estimate the clinical outcome of the infection. [1,2,4,8] The risk of infection is higher in lower extremities compared to the head and upper extremities. The number of bacterial colonization is high in…”