The risk of wound infection after simple hand laceration

BACKGROUND

This prospective observational study aimed to determine the infection rate of simple hand laceration (SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were not.

METHODS

The study was performed at two urban hospitals enrolling 125 emergency department (ED) patients with SHL. Exclusion criteria included patients with lacerations for more than 12 hours, immunocompromized patients, patients given antibiotics, and patients with gross contamination, bites or crush injuries. Wound infection was defined as clinical infection at a follow-up visit (10-14 days) or wound was treated with antibiotics. Patient satisfaction was also measured using a visual analogue scale 1-10, asking the patients about wound appearance. Demographic data and wound characteristics were compared between the infected and non-infected wounds. The infection rates were also compared between patients who received prophylactic antibiotics and those who did not. The results were presented with medians and quartiles or percentages with 95% confidence intervals (CI).

RESULTS

In the 125 patients SHL [median age: 28 (18, 43); range: 1-102 years old; 36% female], 44 (35%, 95% CI: 27%-44%) were given antibiotics in the ED. Wound infection was reported in 6 patients (4.8%, 95% CI: 2%-10%). Age, gender, history of diabetes and wound closure were not associated with wound infection (P>0.05). The infection rate was not significantly different between patients with or without antibiotic prophylaxis [7% (3/44), 95% CI: 2%-10% vs. 4% (3/81), 95% CI: 1%-11%, P=0.66]. Patient's satisfaction with appearance of infected and non-infected wounds were significantly different [7.5 (6, 8) vs. 9 (8, 10), P=0.01].

CONCLUSION

Approximately 5% of simple hand lacerations become infected. Age, gender, diabetes, prophylactic antibiotics and closure technique do not affect the risk of infection.

Effect of microEEG on clinical management and outcomes of emergency department patients with altered mental status: a randomized controlled trial

OBJECTIVES

Altered mental status (AMS) is a common presentation in the emergency department (ED). A previous study revealed 78% electroencephalogram (EEG) abnormalities, including nonconvulsive seizure (NCS; 5%), in ED patients with AMS. The objective of this study was to assess the impact of EEG on clinical management and outcomes of ED patients with AMS.

METHODS

This was a randomized controlled trial at two urban teaching hospitals. Adult patients (≥18 years old) with AMS were included. Excluded patients had immediately correctable AMS (e.g., hypoglycemia) or were admitted before enrollment. Patients were randomized to routine care (control) or routine care plus EEG (intervention). Research assistants used a scalp electrode set with a miniature, wireless EEG device (microEEG) to record standard 30-minute EEGs at presentation, and results were reported to the ED attending physician by an off-site epileptologist within 30 minutes. Primary outcomes included changes in ED management (differential diagnosis, diagnostic work-up, and treatment plan from enrollment to disposition) as determined by surveying the treating physicians. Secondary outcomes were length of ED and hospital stay, intensive care unit (ICU) requirement, and in-hospital mortality.

RESULTS

A total of 149 patients were enrolled (76 control and 73 intervention). Patients in the two groups were comparable at baseline. EEG in the intervention group revealed abnormal findings in 93% (95% confidence interval [CI] = 85% to 97%), including NCS in 5% (95% CI = 2% to 13%). Using microEEG was associated with change in diagnostic work-up in 49% (95% CI = 38% to 60%) of cases and therapeutic plan in 42% (95% CI = 31% to 53%) of cases immediately after the release of EEG results. Changes in probabilities of differential diagnoses and the secondary outcomes were not statistically significant between the groups.

CONCLUSIONS

An EEG can be obtained in the ED with minimal resources and can affect clinical management of AMS patients.

Cultural competencies in emergency medicine: caring for Muslim-American patients from the Middle East

BACKGROUND

Cultural competency is crucial to the delivery of optimal medical care. In Emergency Medicine, overcoming cultural barriers is even more important because patients might use the Emergency Department (ED) as their first choice for health care. At least 2.2 million Muslims from Middle Eastern background live in the United States.

OBJECTIVE

We wanted to create a succinct guideline for Emergency care providers to overcome cultural barriers in delivering care for this unique population.

METHOD

A compensative search on medical and health databases was performed and all the articles related to providing healthcare for Muslim-Americans were reviewed.

RESULT

The important cultural factors that impact Emergency care delivery to this population include norms of modesty; gender role; the concept of God's will and its role in health, family structure, prohibition of premarital and extramarital sex; Islamic rituals of praying and fasting; Islamic dietary codes; and rules related to religious cleanliness.

CONCLUSIONS

The Muslim-American community is a fast-growing, under-studied population. Cultural awareness is essential for optimal delivery of health care to this minority. We have created a succinct guideline that can be used by Emergency Care providers to overcome cultural barriers. However, it is important to consider the heterogeneity and diversity of this population and to use this guideline on an individual basis.