Sutured wounds: Factors associated with patient-rated cosmetic scores

Objective:  To determine the association between wound characteristics, wound management in the ED and patient-rated cosmetic appearance of sutured wounds. Our hypothesis was that practitioner seniority would most strongly predict outcome.

Methods:  Prospective recruitment of patients with lacerations sutured at the primary ED visit was performed. Data collected included patient demographics, wound characteristics and wound management. A standardized telephone questionnaire was administered 14 days and 3 months later. Scar appearance was scored using a verbal rating scale from zero to 10. Data were obtained about suture removal, antibiotic compliance, infection and dehiscence rates at 2 weeks. Associations of variables with cosmetic scores were analysed using multivariate linear regression.

Results:  One hundred and thirty-two patients were evaluated. Mean cosmetic scores were not significantly associated with seniority (P = 0.07). Lacerations repaired by senior practitioners were more likely to result from glass or general trauma (P = 0.007), be shorter (P = 0.03), be cleaned with antiseptic (P = 0.03), not to re-open (P = 0.01) or require re-suturing (P = 0.03). Following multivariate regression factors significantly associated with cosmetic scores at 14 days and 3 months were site of injury (P < 0.003) and time from injury to repair (P < 0.009). Wounds of the torso, leg or foot had lower cosmetic scores at both time-points. An association with age (P = 0.04) was present at 3 months.

Conclusions:  Previous research found improvement between short-term doctor-rated cosmesis and training beyond internship. Our study demonstrated a non-significant trend relationship between seniority and patient-rated outcome, both short and long-term. However, staff seniority was overshadowed by the site of laceration and time from injury to repair.