Care Of Lacerations Research Articles

Measurement of perineal tears as an additional tool for laceration assessment during vaginal birth.

Spontaneous lacerations at vaginal birth are everyday events, but their classification and management still challenge midwifery care. This study aims to measure and describe first-degree and second-degree perineal lacerations resulting from vaginal birth, describe their repair, and the education provided for care. A descriptive study was conducted in a public maternity hospital in São Paulo, Brazil, with 87 parturients. Data were collected between October 2017 and June 2018 using a structured instrument containing obstetric variables and a description of lacerations. The obstetricians and nurse midwives assisted with births, determining the degree of laceration and intervention, and the researchers measured and reported them. The majority of parturients (82.7%) had lacerations only in the anterior region, 8% had them in the posterior region, and 9.2% in both regions. The lacerations were classified as first-degree (78.1%) or second-degree (21.8%). Among the 32 nulliparous parturients, 27.6% had first-degree lacerations, and 9.2% had second-degree. Of the 55 multiparous parturients, 50.6% had first-degree, and 12.6% had second-degree. Among the lacerations assessed as first-degree, 25% had deeper tissue layers compromised in addition to the skin and mucosa. There were 180 lacerations, with an average length of 33.1 mm, depth of 19.8 mm, and width of 23.8 mm. Half of the parturients did not receive guidance on laceration care. There was no association between parity and size, number, location, or degree classification of lacerations. This study provides a broad description of the characteristics of perineal lacerations and presents measurement techniques as a complementary resource for evaluating lacerations.

PHYSIOTHERAPY REHABILITATION IN A PATIENT WITH ANKLE LACERATION

The foot is a complex structure of more than 26 bones, 30 joints, numerous tendons, ligaments, and muscles responsible for our ability to stand upright, supporting the entire body's weight, and providing the basis for the bipedal gait mechanism. Ankle joint is the commonest joint injured in the musculoskeletal injuries without adequate rehabilitation function can be severely impaired, but access to the physiotherapy rehabilitation service can be limited due to geographical remoteness and inadequate or absence of services in the rural areas. Wound complications have been reported to occur in 1.4% to18.8% of patient with ankle injuries. In 2005, nearly 12 per cent of all ER visits or 13.8 million visits for laceration care were reported. Depending on the location and severity of the injury, lacerations can be managed in the ambulatory environment as well. Foot and ankle conditions are common in older adults. The commonest ankle injury is ankle sprain, ankle instability these type on injury are more commonly seen in sports person. Ankle Laceration is a debilitation condition which leads to lack of mobility and if not treated properly may lead to wound infection. As the tendon in the ankle region are more superficial there is high chances of tendon or nerve injury in the cases of ankle laceration. Here presenting a 19 year old girl with a laceration injury on the left ankle while mowing the lawn, she has undergone grafting and since then on physical therapy management.

Utilization of Educational Videos to Improve Communication and Discharge Instructions.

IntroductionWhen discharging a patient from the emergency department (ED), it is crucial to make sure that they understand their disposition and aftercare instructions. However, numerous factors make it difficult to ensure that patients understand their next steps. Our objective was to determine whether patient understanding of ED discharge and aftercare instructions could be improved through instructional videos in addition to standard written discharge instructions.MethodsThis was a prospective pre- and post-intervention study conducted at a single-center, academic tertiary care ED. Patients presenting with the five selective chief complaints (closed head injury, vaginal bleeding, laceration care, splint care, and upper respiratory infection) were given questionnaires after their discharge instructions to test comprehension. Once video discharge instructions were implemented, patients received standard discharge instructions in addition to video discharge instructions and were given the same questionnaire. A total of 120 patients were enrolled in each group.ResultsThere were significantly better survey scores after video discharge instructions (VDI) vs standard discharge instructions (SDI) for the closed head injury (27% SDI vs 46% VDI, P = 0.003); upper respiratory infection (28% SDI vs 64% VDI; P < 0.0001); and vaginal bleeding in early pregnancy groups (20% SDI vs 60% VDI, P < 0.0001). There were no significant differences in survey scores between the splint care (53% SDI vs 66% VDI; P = 0.08) and suture care groups (29% SDI vs 31% VDI; P = 0.40).ConclusionVideo discharge instructions supplementing standard written instructions can help improve patient comprehension and information retention. This better understanding of aftercare instructions is essential to patient follow-up and has been shown to improve patient outcomes.

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

ObjectiveTo 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.MethodsConsecutive patients presenting with traumatic...

Predictors of Parent Satisfaction in Pediatric Laceration Repair

Patient and parent satisfaction are important measures of quality of care. Data are lacking regarding satisfaction with emergency procedures, including laceration repair. The objective was to define the elements of care that are important to parents during a pediatric laceration repair and to determine the predictors of excellent parent satisfaction. This was a cross-sectional observational study of a convenience sample of patients younger than 18 years of age presenting for laceration repair to an urban tertiary care children's hospital emergency department (ED). At the end of the ED visit, parents completed a survey developed for this study assessing ratings of their experience and their perception of how their child experienced the repair. Exploratory factor analysis was used to derive the factors comprising parents' perception of the laceration repair process. A separate factor analysis was performed for the 0- to 4-years age subgroup. Multivariate logistic regression was used to determine which of these factors predicted excellent parent satisfaction with the visit, and also satisfaction with the procedure itself, adjusting for sociodemographic factors. A total of 408 parents returned completed surveys (response rate=76%). Factor analysis revealed that three factors provided a summary of the 16 survey items. They were labeled "provider performance,""anxiety and pain," and "cosmetic appearance," based on factor loading patterns. Provider performance was the only predictor of satisfaction with the visit (adjusted odds ratio [OR]=11.6; 95% confidence interval [CI]=6.2 to 21.6). Provider performance (adjusted OR=4.7; 95% CI=3.1 to 7.2) and cosmetic appearance (adjusted OR 2.7; 95% CI=1.7 to 4.2) predicted satisfaction with the procedure. Anxiety and pain did not predict either outcome. Provider performance, which comprises the elements of physician communication, caring attitude, confidence, and hygiene, is the strongest predictor of excellent parent satisfaction for pediatric patients with ED visits for laceration repair.

The Use of Mobile Phone Cameras in Guiding Treatment Decisions for Laceration Care

Mobile phone technology may be useful in helping to guide medical decisions for lacerations. We examined whether emergency department (ED) provider opinions on which lacerations require repair differed using mobile phone-generated images compared with in-person evaluations. Patients presenting to an urban ED for initial and follow-up laceration care were prospectively enrolled. Patients took four mobile phone pictures of their laceration and provided a medical history. Cases were reviewed by ED providers who assessed image quality and made a recommendation about whether the laceration needed repair. The same provider then assessed the patient in-person. Concordant decision-making between mobile phone and in-person assessments was calculated as well as the degree of undertriage. In total, 94 patients were included over an 8-month period. There was complete agreement in 87% of cases (κ statistic=0.65). Of the 13 patients with discrepant decisions, 6 were due to poor image quality, in 3 the images did not properly represent the problem, in 3 others there were historical findings that altered care, and for 1 the image looked worse than the actual injury in-person. In total, 5 of 94 (5%) of cases would have been undertriaged using only the mobile phone recommendation. Median image quality was 6 out of 10 (with 10 being the best) (interquartile range, 4-8). There are high rates of agreement when providers use mobile phone images to assess lacerations for possible repair in the ED. Image quality is in general good but highly variable and may drive incorrect assessments.

The Use of Mobile Phones for Acute Wound Care: Attitudes and Opinions of Emergency Department Patients

There are a significant number of emergency department (ED) visits for lacerations each year. When individuals experience skin, soft tissue, or laceration symptoms, the decision to go to the ED is not always easy on the basis of the level of severity. For such cases, it may be feasible to use a mobile phone camera to submit images of their wound to a remote medical provider who can review and help guide their care choice decisions. The authors aimed to assess patient attitudes toward the use of mobile phone technology for laceration management. Patients presenting to an urban ED for initial care and follow-up visits for lacerations were prospectively enrolled. A total of 194 patients were enrolled over 8 months. Enrolled patients answered a series of questions about their injury and a survey on attitudes about the acceptability of making management decisions using mobile phone images only. A majority of those surveyed agreed that it was acceptable to send a mobile phone picture to a physician for a recommendation and diagnosis. Patients also reported few concerns regarding privacy and security and believe that this technology could be cost effective and convenient. In this study, the majority of patients had favorable opinions of using mobile phones for laceration care. Mobile phone camera images (a) may provide a useful modality for assessment of some acute wound care needs and (b) may decrease ED visits for a high-volume complaint such as acute wounds.

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A Wound-Care Process Model Improves Emergency Department Turnaround Time

Numerous studies demonstrate that patient satisfaction correlates with perceived timeliness of care. Turnaround time data identified Laceration patients as a subset of emergency department patients who were not receiving high-quality care. With the Define-Measure-Analyze- Devise-Verify methodology, root causes of delay in operations were sought, and remedies were devised. An education module and an improved patient-care process model were implemented. Through the use of continuous quality improvement, a wound-care process model improved turnaround times for laceration care by 30 minutes.

Predictive value of emergency department patients’ self-efficacy beliefs on follow-up care of lacerations

Summary Background Patients receiving wound care in the emergency department (ED) often do not follow instructions or return for follow-up appointments sometimes resulting in complications. This research examined self-efficacy and outcome beliefs regarding wound care and their relationship to patients' returning to the ED to have sutures removed. Methods This study included a convenience sample of 100 patients requiring sutures for lacerations who presented to the EDs of a suburban and a community hospital in the United States each with an annual ED census of greater than 50,000. Participants completed the wound care questionnaire (WCQ), a self-efficacy and outcome beliefs instrument. Results Self-efficacy beliefs for following laceration care instructions including returning to the ED were identified as significant predictors of patients who returned and those who did not return to the ED for suture removal. Additionally, older age was a significant predictor of return to the ED for suture removal, but outcome beliefs were not. Conclusions The WCQ, completed by ED patients requiring sutures for lacerations, can be used by nurses to predict which patients will return to the ED for suture removal. This is one of the first studies to identify self-efficacy as a predictor of follow-up behavior in the ED.

Assessment and initial treatment of lacerations, mammalian bites, and insect stings.

Millions of wounds are seen in emergency rooms across the United States each year. The goals of wound care for all ages are to avoid infection and achieve an esthetically pleasing and functional scar. This article reviews the care needs associated with acute traumatic wounds. Information presented includes anatomy and physiology of skin and wound healing, and assessment and care of lacerations, bites, and sting wounds.

Appearance scales to measure cosmetic outcomes of healed lacerations

To develop an appearance scale that will allow the objective and scientific comparison of the cosmetic results of healed lacerations, 33 photographs of healed lacerations and incisions with variable cosmetic results were shown to four plastic surgeons. These plastic surgeons were asked to independently rate the photographs on two separate occasions using two scales, a Visual Analogue Scale and a Categorical Scale. Interobserver and intraobserver agreement were determined for each scale. Comparison of the scales with each other was done to assess consistency. The Visual Analogue Scale showed good interobserver agreement with an Intraclass Correlation Coefficient of 0.75. Intraobserver agreement was also high across the four observers with Pearson correlation coefficients ranging from 0.73 to 0.87. The agreement of the categorical scale was also good with a kappa coefficient for interobserver agreement of 0.53. The kappa coefficient for intraobserver agreement ranged from 0.48 to 0.72. Because the visual analogue scale and categorical scale showed good interobserver and intraobserver agreement, both may be considered good measurement tools in the comparison of alternate methods of laceration care.

Office care of lacerations in children.

Office care of lacerations in children.