A Randomized, Controlled Trial Comparing Long-term Cosmetic Outcomes of Traumatic Pediatric Lacerations Repaired with Absorbable Plain Gut versus Nonabsorbable Nylon Sutures

OBJECTIVES: To show that the use of absorbable sutures in pediatric traumatic lacerations affords good long-term cosmesis and no increase in complications (infection, dehiscence rates, and need for surgical scar revision) when compared with wounds sutured with nonabsorbable sutures. METHODS: This was a randomized clinical trial conducted in a pediatric emergency department. Patients 1-18 years of age who presented to the emergency department with lacerations < 12 hours old were recruited between January 1999 and December 2001. Exclusion criteria were the following: wounds that could be approximated by tissue adhesives, animal/human bites, gross contamination, puncture/crush wounds, wounds crossing joints, lacerations of tendon/nerve/cartilage, collagen vascular disease, immunodeficiency, diabetes mellitus, bleeding disorder, and scalp lacerations. Patients were randomized into one of two groups: those receiving absorbable plain gut sutures (group A) and those receiving nonabsorbable nylon sutures (group NA). Board-eligible/certified pediatric emergency physicians or clinical fellows performed laceration repair in a standardized approach. All wounds were reevaluated within ten days by a single research nurse who assessed the wounds using a previously validated wound evaluation score (WES) composed of six items (presence of step-off, contour irregularities, margin separation, edge inversion, extensive distortion, and overall cosmetic appearance). A score of 6/6 was considered optimal. The study nurse also noted the presence of infection and dehiscence. The patients were then seen by a single blinded plastic surgeon at four or five months who evaluated the wound using a previously validated visual analog scale of cosmesis (VAS). In addition, the surgeon repeated the WES and assessed the need for surgical scar revision. RESULTS: A total of 147 patients were eligible, and 52 patients declined to participate. Of the 95 patients enrolled, 50 were randomized to group A and 45 to group NA. The two groups had similar ages, gender distributions, rates of use of sedation or steri-strips, wound lengths and widths, mechanisms of injury, and wound locations. At the short-term follow-up, no difference was found in the proportion of optimal WES scores between group A (63% of patients) and group NA (49% of patients) (relative risk = 0.73; 95% confidence interval [95% CI] = 0.45 to 1.17). No difference was found in the rates of infection and dehiscence between the two groups. Sixty-three of the 95 patients presented for long-term follow-up. The groups remained similar with respect to patient and wound characteristics as well as wound location. The average VAS score at four months was 79 (95% CI = 73 to 85) for group A and 66 (95% CI = 55 to 76) for group NA. In addition, no differences were found in the proportion of optimal WES between group A (36% of patients) and group NA (28% of patients) at four months (relative risk = 0.88; 95% CI = 0.62 to 1.26). Surgical scar revision was recommended for only three patients, of whom two were in group A. No patients chose to have their scars revised. No differences were found between group A and group NA for the rates of dehiscence (2% vs. 11%; p = 0.07) and infection (0 vs. 2; p = 0.3). CONCLUSIONS: The use of plain catgut absorbable sutures in the repair of traumatic lacerations in children appears to be an acceptable alternative to nonabsorbable sutures because the long-term cosmetic outcome seems to be at least as good. In this study, plain gut suture material seemed to provide slightly better cosmesis. In addition, no difference was found in the rate of dehiscence or infection between the groups.     

An Assessment of Clinical Wound Evaluation Scales

Abstract. Objective : To compare 2 clinical wound scales and to determine a minimal clinically important difference (MCID) on the visual analog cosmesis scale. Methods : Using data from 2 previously published clinical trials, 91 lacerations and 43 surgical incisions were assessed on the 2 scales; a 100-mm visual analog scale (VAS) (0 = worst possible scar, 100 = best possible scar) and a wound evaluation scale (WES) assessing 6 clinical variables (a score of 6 is considered optimal, while a score of ≤5 suboptimal). All wound assessments on the VAS were done by 2 cosmetic surgeons who rated photographs on 2 occasions. A cohort of wounds on the WES were assessed by a second observer. The difference of the mean optimal and suboptimal VAS scores for each study was used to determine a MCID on the VAS scale. Results : The VAS scale yielded intraobserver agreements of 0.93 and 0.87 (95% CI: 0.89–0.96 and 0.78–0.93) and interobserver agreements of 0.50 and 0.71 (95% CI: 0.32–0.65 and 0.52–0.84) for lacerations and incisions, respectively. Kappa coefficient measuring agreement on the WES was 0.79 (95% CI: 0.57–1.0). The mean (±SD) VAS scores of optimal wounds were 72 ± 12 mm and 65 ± 20 mm, while the mean scores of suboptimal wounds were 57 ± 17 mm and 50 ± 23 mm for lacerations and incisions, respectively. Conclusions : An MCID on the VAS cosmesis scale is 15 mm. Studies should be designed to have a sample size and power to detect this difference.     

Application of Tissue Adhesives: Rapid Attainment of Proficiency

Abstract. Objective:To evaluate the 3-month cosmetic outcome following laceration repair with a new tissue adhesive, 2-octylcyanoacrylate, as a function of physician experience with this tissue adhesive.
Methods:The authors prospectively enrolled consecutive patients <1 year of age with non-bite, non-crush-induced lacerations who presented <6 hours after injury and were treated with 2-octylcyanoacrylate. Structured closed-question data sheets were completed at the time of laceration repair and at 3-month follow-up. Long-term cosmetic appearance (<3 months) was assessed by patients using a 100-mm visual analog scale. The cosmetic outcomes were evaluated as a function of the physician application using ANOVA or x² tests, as appropriate. This study had 80% power to detect a 10-mm difference between the 2-octylcyanoacrylate and suture groups (α, 0.05).
Results:Seven physicians applied 2-octylcyanoacrylate to 63 patients; 61 patients received sutures. Patients were similar in the 2 groups (age, gender, race, history, and wound characteristics; p < 0.05 for all). At long-term follow-up, the cosmetic outcomes were similar in the 2-octylcyanoacrylate and suture groups according to patients (VAS 83.8 ± 19.4 mm vs 82.5 ± 17.6 mm; p = 0.72) and physicians (optimal score, 77% vs 80%; p = 0.67), and independent of physician experience with the 2-octylcyanoacrylate. One wound developed an infection and one wound necessitated reclosure due to dehiscence. Neither occurred with the first application.
Conclusions:The 3-month cosmetic appearance of wounds treated with 2-octylcyanoacrylate is equivalent to that with sutures and does not improve as physicians become more experienced with use of this tissue adhesive. These data suggest that physicians can develop competence in application of tissue adhesives with a brief training period.     

Prospective, Randomized, Controlled Trial of Tissue Adhesive (2-Octylcyanoacrylate) vs Standard Wound Closure Techniques for Laceration Repair

Objective: To compare a new tissue adhesive, 2-octylcyanoacrylate, with standard wound closure techniques for the repair of traumatic lacerations.
Methods: A prospective, randomized, controlled clinical trial enrolled consecutive patients >1 year of age with non-bite, non-crush-induced lacerations who presented <6 hours after injury. Structured closed-question data sheets were completed at the time of laceration repair and suture removal. Patients were randomly assigned to treatment with either 2-octylcyanoacrylate or standard wound closure. Infection was determined at the time of suture removal. Long-term cosmetic appearance (>3 months) was assessed by physicians using a previously validated categorical cosmetic scale and by patients using a 100-mm visual analog scale.
Results : There were 63 patients randomized to the octylcyanoacrylate group and 61 patients treated with standard wound closure techniques. The 2 treatment groups were similar with respect to age, gender, race, medical history, and wound characteristics. At the 5-to-10-day follow-up, only 1 wound was infected and only 2 wounds required reclosure due to dehiscence. These 3 patients received treatment with octylcyanoacrylate. At long-term follow-up, the cosmetic appearances were similar according to the patients (octylcyanoacrylate, 83.8 ± 19.4 mm vs standard techniques, 82.5 ± 17.6 mm; p = 0.72) and the physicians (optimal cosmetic appearance, 77% vs 80%; p = 0.67).
Conclusions: Wounds treated with octylcyanoacrylate and standard wound closure techniques have similar cosmetic appearances 3 months later.     

血液透析患者院内感染危险因素分析

目的：探讨尿毒症血液透析(血透)病人院内感染的危险因素和预防措施。方法：204例住院血透病人中29例发生院内感染，对年龄、贫血、左心衰、血浆白蛋白、侵袭性治疗、感染部位和时间、诱发因素进行评估。结果：当血透病人出现下列情况之一：年龄超过60岁，血红蛋白低于60g／L，血浆白蛋白低于30g／L，有左心衰竭或有静脉插管．其院内感染率明显增加。左心衰竭易出现肺感染，低蛋白血症者易出现动静脉吻合口处感染，静脉导管出口处感染与保留导管时间过长明显相关。结论：血透患者发生院内感染与医疗行为有关．积极控制易患因素能有效减少院内感染。     

维持性血液透析患者丙型肝炎病毒感染危险因素分析

目的探讨维持性血液透析（MHD）患者丙型肝炎病毒（HCV）感染危险因素,为临床防控提供科学依据。方法收集2017年12月至2019年12月在南昌大学第一附属医院行维持性血液透析治疗达3个月以上患者392例为研究对象,收集患者一般资料、临床资料及实验室检测数据,透析前后对所有患者行丙型肝炎病毒抗体（抗-HCV）检测。比较受试者透析治疗后HCV感染阳性患者（阳性组）与HCV感染阴性组患者（阴性组）的相关资料,采用Logistic多因素回归分析分析维持性血液透析感染HCV的危险因素。结果 392例MHD患者透析治疗后HCV感染20例,丙型肝炎发生率为5.1%。Logistic多因素回归分析显示,透析时间长、输血次数多、频繁异地透析、肾移植史等因素是HCV感染的危险因素。结论血液透析是丙型肝炎病毒感染的高危人群,丙型肝炎病毒感染与输血次数、透析时间长短及频次、肾移植史等因素密切相关。严格按照《血液净化标准操作规程》认真操作,可明显减少医源性HCV交叉感染的发生。     

结直肠癌患者手术切口感染危险因素的Meta分析

目的 通过Meta分析探讨结直肠癌患者手术切口感染的危险因素,为制定预防措施提供参考依据。方法 计算机检索中国知网、中国生物医学文献数据库、万方数据库、维普数据库、The Cochrane Library、PubMed、Embase、Web of Science数据库,收集关于结直肠癌手术切口感染危险因素的病例对照研究和队列研究。由2名研究者根据纳入与排除标准进行文献筛选,并运用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale,NOS）对纳入文献进行质量评价。结果 最终纳入17篇文献,累计结肠癌患者16 992例。Meta分析结果显示糖尿病（OR=1.65,95%CI:1.48~1.84）、手术时间≥3 h（OR=1.41,95%CI:1.22~1.63）、体质量指数（Body Mass Index, BMI）≧30 kg/m²（OR=1.35,95%CI:1.18~1.55）、开腹手术（OR=1.60,95%CI:1.23~2.07）、手术方式（OR=1.69,95%CI:1.38~2.08）、肿瘤分期（OR=1.42,95%CI:1.28~1.58）、年龄（OR=1.28,95%CI:1.12~1.47）为结直肠癌患者手术切口感染的危险因素。敏感性分析与发表偏倚结果显示各因素合并结果比较稳定,发表偏倚不明显。结论 对结直肠癌患者基础疾病、手术时间、体质量、手术方式、肿瘤分期及年龄等进行管理可有效降低手术切口感染的发生率。     

肾病综合征医院感染分析

目的 :探讨肾病综合征发生医院感染的危险因素。方法 :回顾性总结 187例肾病综合征患者临床特征与医院感染的关系 ,进行病例对照研究和非条件logistic多元回归模型分析。结果 :筛选出了 4个危险因素 ,即血清血白蛋白降低 ,血清尿素氮水平升高 ,血清IgG水平降低和住院天数。结论     

终末期糖尿病肾病患者血液透析合并肺部感染危险因素分析

目的探讨终末期糖尿病肾病患者血液透析肺部感染的危险因素。方法2000年8月至2003年8月住院的终末期糖尿病肾病患者182例,合并肺部感染者54例,同时随机选取无肺部感染者58例,两组进行比较。结果终末期糖尿病肾病患者血液透析合并肺部感染与年龄、高血糖、高糖化血红蛋白、贫血、血清白蛋白降低、容量负荷过多等因素有关。结论积极控制血糖、纠正贫血、改善营养、充分透析是减少肺部感染的关键。     

神经内科危重患者院内感染的相关危险因素分析及防治措施

目的 探讨神经内科危重患者院内感染发生的危险因素及防治措施.方法 对选取的416例神经内科危重患者中发生感染的227例（54.57％）的年龄、疾病种类、感染部位、病原菌种类等危险因素进行分析.结果 416例神经内科危重患者共发生医院内感染227例,感染率54.57％.本研究分析与医院感染相关的因素,发现年龄越大（＞60岁者感染112例,占49.3％）、住院时间越长（＞28 d者感染88例,占38.8％）感染率越高;感染疾病种类以脑梗死（99例,占43.6％）及高血压脑出血（61例,占26.9％）感染例数最多;感染部位从高到低依次为上呼吸道59例（26.0％）,下呼吸道45例（19.8％）,口腔36例（15.9％）,泌尿系统31例（13.7％）,消化系统25例（11.0％）,皮肤20例（8.8％）,其他11例（4.8％）;有侵入性操作、合并基础疾病、使用抗菌素及糖皮质激素者感染率高,差异均有统计学意义（P＜0.05）.结论 患者住院时间、侵入性操作、合并基础病变、使用抗菌药物是神经内科危重患者医院感染发生的危险因素,医护人员控制相关危险因素,可有效预防医院感染.     

血液肿瘤患者化疗后肛周感染危险因素病例对照研究

目的 探讨血液肿瘤患者接受化疗后发生肛周感染的危险因素.方法 采用回顾性病例对照研究的方法,对四川省某三级甲等医院血液内科2020年12月—2021年5月收治的进行化疗的348例血液肿瘤住院患者相关资料(人口学特征、疾病特征、医疗及护理病例记录、实验室检查结果)予以回顾性分析,根据出院诊断发生肛周感染的病例作为病例组,...     

激素联合免疫抑制剂治疗天疱疮引起真菌感染的危险因素及护理

目的探讨激素联合免疫抑制剂治疗天疱疮患者发生真菌感染的危险因素及护理方法。方法回顾性分析2001年5月至2010年12月中国医学科学院皮肤病医院收治的33例激素联合免疫抑制剂治疗天疱疮真菌培养阳性患者的临床资料,总结其危险因素及护理方法。结果 33例患者中25例经治疗痊愈,治愈率为75.8%。患者无复发,也未见其他部位发生真菌感染。结论激素联合免疫抑制剂治疗天疱疮真菌感染发生率高。加强皮损护理,合理使用抗生素,正确认识天疱疮真菌感染发生的危险因素及有效的护理干预是预防和减少天疱疮真菌感染的关键。     

尿毒症肺部感染危险因素分析

目的：探讨致尿毒症部感染的危险因素,方法：本院１９９８年９月～１９９９年１２月住院的尿毒症患１７６例,合并肺部感染４０例,与无感染４６例比较,结果：尿毒症合并肺部感染与盆血,血清白蛋降低有显差异（Ｐ〈０．０５）,未血透患还与血肌酐升高有非常显差异（Ｐ〈０．０１）,结论：纠正贫血、改善营养、充分透析、加强重视呼吸管理是减少尿毒症肺部感染的关键。     

ICU患者耐碳青酶烯-鲍曼不动杆菌阳性危险因素探讨

目的探讨与ICU患者临床标本耐碳青酶烯鲍曼不动杆菌(Carbapenem-risistant Acinetobacter baumannii,CRA．b)阳性相关的危险因素,评估联合使用多种感染控制措施的有效性,为临床预防CRA．b的爆发流行提供依据。方法 对2000年9月至2001年11月间西南医院ICU患者进行前瞻性纵向干预调查并对临床标本鲍曼不动杆菌阳性患者进行分析。结果 通过CRA．b阳性患者和对碳青酶烯敏感的鲍曼不动杆菌(Carbapenem-susceptible Acinetobacter baumannii,CSA．b)阳性患者危险因素的比较,发现CRA．b阳性患者多有碳青酶烯类抗生素使用史、所在病房中CRA．b阳性患者较多、肠道携带CR-Ab的比率较高。联合采取了多种感染控制措施后,新患者临床标本鲍曼不动杆菌的阳性检出率大幅度下降。结论 限制碳青酶烯类抗生素的使用,严格遵守基本的感染控制措施可能对控制鲍曼不动杆菌的爆发流行有很大的作用。     

A Randomized, Clinical Trial Comparing Butylcyanoacrylate with Octylcyanoacrylate in the Management of Selected Pediatric Facial Lacerations

OBJECTIVE: To compare two tissue adhesives, butylcyanoacrylate and octylcyanoacrylate, in the treatment of small (<4 cm) superficial linear traumatic facial lacerations in children. METHODS: This was a randomized, clinical trial with parallel design. 94 children <18 years of age seen in the ED of a tertiary care pediatric hospital with a facial laceration suitable for tissue adhesive closure underwent laceration closure using either butylcyanoacrylate or octylcyanoacrylate. The primary outcome was the cosmetic result at three months rated from photographs by a plastic surgeon on a visual analog scale (VAS). Secondary outcomes included the time to perform the procedure, the perceived difficulty of the procedure, the pain perceived by the patient, and a wound evaluation score at ten to 14 days and three months. RESULTS: Ninety-four patients were randomized with 47 in each group. The two groups were similar for baseline demographic and clinical characteristics. There was no difference in the three-month cosmesis VAS (median, 70.0 mm for n-butyl-2-cyanoacrylate vs 67.5 mm for octylcyanocrylate, p = 0.84). There was no difference between the groups for time to complete the procedure (p = 0.88), parent/patient-perceived pain of the procedure (p = 0.37), or physician-perceived difficulty of the procedure (p = 0.33). Similarly, there was no difference between the groups for the percentage of early (p = 0.58) or late (p = 0.71) optimal wound evaluation scores. CONCLUSIONS: In the closure of small linear pediatric facial lacerations, octylcyanoacrylate is similar to butylcyanoacrylate in ease of use and early and late cosmetic outcomes. The superior physical properties of octylcyanoacrylate appear to add little benefit to the management of these selected lacerations. Physician preference and differing costs may dictate use for these small selected lacerations.     

成人急性白血病患者医院感染危险因素分析

目的 探讨引起成人急性白血病患者医院感染的危险因素,为医院感染预防措施的制定提供客观依据。方法 对某三级甲等医院血液科2005年7月—2007年7月住院治疗的653例急性白血病病例进行回顾性调查研究,填写统一的个案登记表。其中386例为医院感染组,267例无任何感染者为非医院感染组,对两组资料进行单因素!2检验和多因素的非条件Logistic回归分析。结果 医院感染的发生率为59.1%,多因素分析得出差异有统计学意义的危险因素有5项,分别为：预防性使用抗生素、使用糖皮质激素、肛周疾患、血红蛋白量、血小板计数。结论 成人急性白血病患者医院感染率高。预防性使用抗生素、使用糖皮质激素和肛周疾患是成人急性白血病患者发生医院感染的独立危险因素,血红蛋白量及血小板计数是医院感染的保护因素。     

老年患者院内肺部感染的相关危险因素分析及护理对策

目的：确定多种危险因素与老年病患院内肺部感染的相关性，为 预防和控制院内感染提供依据。方法：选取西南医院呼吸内科2000年4月至2001年3月的老年住院患（年龄≥60岁），发生 院内肺部感染患（病例组）26例，无院内肺部感染患（对照组）64例，进行成组不匹配病例对照研究。结果：除放、化疗外，病例组与对照组在年龄、治疗措施（包括：介入性检查、治疗，多种抗生素的联合使用，吸氧、肾上腺皮质激素的应用）及住院天数上均相差非常显，P＜0．01；OR值均大于3。结论：老年患的年龄、吸氧、介入性的检查治疗措施、 住院时间长，及肾上腺皮质激素的应用，不合理使用抗生素是造成老年患肺部院内获得性感染的相关危险因素。     

成都市某二级甲等医院发生术后医院感染现状及相关因素研究

目的对外科手术患者术后发生医院感染的情况进行目标性监测,探讨影响术后发生医院感染的相关危险因素,为制定医院感染控制措施提供科学依据。方法2011年7月-2012年6月采用整群抽样的方法,对成都市某二级甲等医院骨科、神经外科和胸外科手术患者647例采用统一的调查表进行前瞻性调查。调查内容包括患者的一般情况、手术情况、抗菌药物使用情况和医院感染情况。资料分析采用全国医院感染监测网软件及单因素妒检验进行分析。结果共发生术后医院感染50例次,医院感染例次发病率为7．73％;术后医院感染发病率最高的科室为神经外科;感染高发部位为下呼吸道和手术部位。围手术期抗菌药物使用时间不同,感染发病率不同,差异有统计学意义（Х^2=601．50,P〈0．001）;医生调整术后医院感染发病专率除神经外科1名医生外其余医生均高于调整前。影响该院术后感染的危险因素主要为基础疾病、急诊手术、麻醉方式、手术时间、住院时间和术后引流等;引发该院医院感染的细菌主要为口杆菌,常见病原菌为肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌。结论应特别加强神经外科术后医院感染的预防与控制;对伴有基础疾病的患者,术前应积极改善患者身体状况,控制原发病灶;针对不同的外科手术相关因素采取有针对性的控制措施;应根据流行菌株合理选择抗菌药物。     

老年血液透析患者肺部感染因素分析及护理干预

目的:研究老年血液透析患者并发肺部感染的相关因素及护理干预的作用,为降低此类患者肺部感染率提供依据。方法:对照分析既往的78例老年血液透析患者潜在肺部感染的相关因素,对95例老年血液透析患者,采用预防肺部感染的综合性护理措施,比较其肺部感染的发生率。结果:老年血液透析患者肺部感染与免疫功能缺陷、营养不良、多种合并症、家庭社会支持、心理因素等关系密切,采用预防性护理干预后,95例老年血液透析患者的肺部感染发生率明显降低。结论:在老年血液透析护理中,采用预防性护理干预,有利于降低肺部感染的发生率。     

A Prospective Evaluation of Risk Factors for Infections from Dog-bite Wounds

Objective: To define risk factors for infections from dog-bite wounds and to model the probability of wound infection in patients presenting without infection who are treated as outpatients. Methods: A prospective survey of 769 consecutive dog-bite victims presenting over a two-year period to a community hospital emergency department (ED) with an emergency medicine residency program. A standardized wound-cleaning protocol was used, which included debride-ment and wound closure when indicated. Wounds were examined for infection at follow-up. Variables analyzed included demographic data (patient age, gender, race); wound information (wound age, type, number, location, depth); and treatment (prior to hospital, ED debridement, suturing, tetanus or rabies shots, antibiotics). Results: There were 734 patients with complete records. These patients had a mean age of 13.4 ± 13.2 years (range, 4 months to 71 years). Infection was evident in 2.5% of the wounds upon presentation. There were 704 patients (765 wounds) managed as outpatients and without wound infection at initial presentation. Wounds were distributed as follows: 26.7% head/neck, 20.4% hand, 15.7% arm, 10.1% trunk, 9.5% thigh, 15.9% leg, and 1.7% foot. There were 32.9% puncture, 39.9% full-thickness, and 60.1% partial-thickness wounds. Wound infections were diagnosed in 2.1% of these wounds at follow-up. Wounds requiring surgical debridement had a sevenfold higher infection rate (p = 0.01). Patients more than 50 years of age had a sixfold higher infection rate than younger patients (p = 0.05). Stepwise logistic regression found the following variables to be the best predictors for wound infection: full-thickness [p = 0.006, odds ratio (OR) = 6.23], female gender (p = 0.048, OR = 2.88), and wound debridement (p = 0.024, OR = 5.01). Combinations of these three variables predict infection rates from 0.35% to 23.9%. Conclusion: A low wound infection rate was seen in this cohort of dog-bite victims who were treated on an outpatient basts. Wound depth, patient gender, and wound debridement were the clinical variables that best predicted the likelihood of developing infection. Future intervention-al studies should concentrate on wounds with high probabilities of infection.