Traumatic lacerations: what are the risks for infection and has the 'golden period' of laceration care disappeared?
Level 3 - non-randomized controlled study
Prospective cohort study tracking consecutive patients across multiple emergency departments for 30 days.
PubMed 23314208 · doi:10.1136/emermed-2012-202143
What was done
Consecutive patients presenting with traumatic lacerations across three diverse emergency departments were prospectively enrolled. Twenty-seven clinical variables were recorded at the initial encounter, and patients were followed for 30 days to assess wound infection and desire for scar revision. Infection rates were compared between wounds closed before versus after 12 hours from injury.
What was found
A total of 2663 patients completed follow-up, and 69 (2.6%, 95% CI 2.0% to 3.3%) developed a wound infection. Significant risk factors for infection were lower extremity location (RR 4.1, 95% CI 2.5 to 6.8), length greater than 5 cm (RR 2.9, 95% CI 1.6 to 5.2), diabetes (RR 2.70, 95% CI 1.1 to 6.5), and wound contamination (RR 2.0, 95% CI 1.2 to 3.4). Infection rates did not differ significantly between wounds closed before 12 hours (3%, 95% CI 2.3% to 3.8%) and those closed after 12 hours (1.2%, 95% CI 0.03% to 6.4%). Infected wounds had worse cosmetic ratings and higher desire for scar revision (RR 2.6, 95% CI 1.7 to 3.9).
Why it matters
This study challenges the traditional rigid 12-hour 'golden period' rule for traumatic wound closure, showing that anatomical location, size, contamination, and patient comorbidities are the primary drivers of infection risk.
Limits
The observational design allows potential selection bias in which wounds clinicians chose to close after 12 hours. The confidence interval for infection in the delayed closure group was wide (0.03% to 6.4%), reflecting low numbers of late closures. Specific details regarding irrigation techniques, closure methods, prophylactic antibiotic use, and the proportion of patients lost to follow-up were not reported in the abstract.
Cited by
- contradicts Lacerations must be sutured within 6 hours of injury to avoid wound infection.