Quality and productive efficiency in simple laceration treatment

Risk Factors for Infection of Sutured Maxillofacial Soft Tissue Injuries

Background: Maxillofacial soft tissue injuries (STIs) are common and frequent in emergency departments. The aim of this study was to analyze factors causing infection of maxillofacial STIs. Patients and Methods: Patients with maxillofacial STIs who received sutures and had complete medical records were evaluated. Gender, age, American Society of Anesthesiologists (ASA) grade, diabetes mellitus, wound age, wound length, wound contamination, wound type, and sites were analyzed using univariable analysis and binary logistic regression. Results: There were 3,276 cases included. In the univariable analysis, there was no significant difference in the infection rate between genders or between the wound age groups. In binary logistic regression, age, wound length, wound type, and physician level were risk factors for infection: age of 18-44 years (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7-2.9), 44-64 years (OR, 3.1; 95% CI, 2.3-4.3), and ≥65 years (OR, 2.6; 95% CI, 1.7-4.1); wound length of 4-8 cm (OR, 1.7; 95% CI, 1.3-2.2) and >8 cm (OR, 2.4; 95% CI, 1.1-5.1); intra-oral wounds (OR, 1.6; 95% CI, 1.1-2.4) and communicating wounds (OR, 3.2; 95% CI, 2.3-4.4); junior specialists (OR, 1.6; 95% CI, 1.2-2.2); and lip (OR, 3.7; 95% CI, 1.1-12.0) and cheek (OR, 4.7; 95% CI, 2.3-17.1) sites. Wound contamination, ASA grade, and diabetes mellitus were not significantly different from wound infection in binary regression analysis. Conclusions: Age (>18 years old), wound length (>4 cm), intra-oral wounds, communicating wounds, suturing by junior surgeons, and lip or cheek injuries may be risk factors for maxillofacial STI infection. Even if the penetrating wound age exceeds 24 hours, it is meaningful to suture if there is no serious infection. For wounds at high risk of infection, further measures should be considered to reduce the possibility of infection, such as improving the surgical training of junior surgeons and improving the patient's wound care.

Head and Neck Injuries Associated With Cell Phone Use

Importance

As cell phones gain more influence in daily life, they also become potentially more hazardous. Injuries resulting from cell phone use have long been reported largely in the context of driving-related incidents, but other mechanisms of injury have been underreported.

Objective

To assess the incidence, types, and mechanisms of head and neck injuries associated with cell phone use.

Design, Setting, and Participants

Retrospective cross-sectional study using data from a national database of individuals with head and neck injuries related to cell phone use who presented to emergency departments in the United States between January 1998 and December 2017.

Main Outcomes and Measures

Incidence, types, and mechanisms of injury related to cell phone use in the US population.

Results

A reported total of 2501 patients (1129 [55.0%] female, 795 [38.8%] white, and 772 [37.6%] aged 13-29 years) presented with injuries of the head and neck related to cell phone use; the estimated weighted national total was 76 043 patients (42 846 females [56.3%], 34 894 [45.9%] white, and 29 956 [39.4%] aged 13-29 years). The most commonly reported subsites of injuries in the head and neck region included the head (33.1% of estimated total); face, including eyelid, eye area, and nose (32.7%); and neck (12.5%). The most common injury diagnoses included laceration (26.3% of estimated total), contusion/abrasion (24.5%), and internal organ injury (18.4%). Age group distributions showed that most injuries associated with cell phone user distraction occurred among individuals aged 13 to 29 years (60.3%; Cramer V = 0.29). In addition, those younger than 13 years were significantly more likely to sustain direct mechanical injury from a cell phone (82.1%) than to have a cell phone use-associated injury (17.9%) (Cramer V = 0.305), whereas a cell phone use-associated injury was more likely than a direct mechanical injury to occur among those aged 50 to 64 years (68.2% vs 31.8%; Cramer V = 0.11) and those older than 65 years (90.3% vs 9.7%; Cramer V = 0.29).

Conclusions and Relevance

Cell phone-related injuries to the head and neck have increased steeply over the recent 20-year period, with many cases resulting from distraction. Although the disposition of most cases is simple, some injuries bear a risk of long-term complications. Many of these injuries occurred among those aged 13 to 29 years and were associated with common activities, such as texting while walking. These findings suggest a need for patient education about injury prevention and the dangers of activity while using these devices.