Surgical Specialty Consultation for Pediatric Facial Laceration Repair

Abstract

Objective We sought to describe patterns of and indications for surgical specialty consultation for facial laceration repair in pediatric emergency departments (PEDs). Methods We performed a multicenter survey of PED leadership throughout the United States and Canada evaluating the practice patterns of surgical specialty consultation for patients presenting for facial lacerations requiring repair. We measured demographics of PEDs, factors influencing the decision to obtain a surgical specialty consultation, and the presence and components of consultation guidelines. Factors related to consultation were ranked on a Likert scale from 1 to 5 (1 = Not at all important, 5 = Extremely important). We evaluated relationships between reported rates of surgical specialty consultation and PED region, annual PED volume, and reported factors associated with PED consultation. Results Survey responses were received from 67/124 (54%) queried PEDs. The median self-reported rate of surgical specialty consultation for facial lacerations was 10% and ranged from 1% to 70%, with resident physicians performing the repair 71% of the time a subspecialist was consulted. There was regional variability in specialty consultation, with the highest and lowest rate in the Midwest and Canada, respectively (P = 0.03). The top 4 influential factors prompting consultation with the highest percentage of responses of “Extremely Important” or “Very Important” were: discretion of the physician caring for the patient (95%), parental preference (39%), limited PED resources (32%), and patient requires sedation (32%). Surgical specialty consult guidelines were used in only 6% of PEDs with consensus that depth necessitating more than 2-layer repair or involvement of critical structures should prompt consultation. Conclusions Surgical specialty usage in the management of patients who present with facial lacerations to PEDs has significant variation related to patient, provider, and department-level factors that influence the decision to consult. Lack of consult guidelines represent a potential opportunity to standardize care delivery to this common presentation.