Skin tapes and tissue adhesive vs. either method alone for laceration repair in a porcine model

STUDY OBJECTIVE

To determine whether the combination of skin tapes and tissue adhesive is superior to either method alone for laceration repair.

METHODS

This was a prospective, longitudinal experiment on six anesthetized swine. Thirty-six full-thickness linear wounds were created using a metal template, then closed using one of three methods: skin tapes over benzoin, tissue adhesive, or a combination of both. The study was done in two parts. Group 1 (immediate excision) animals were euthanized at day zero for skin excision and tensile strength testing following wound repair. Group 2 (delayed excision) had initial wound repair; animals were euthanized at day 35 for skin excision and tensile strength testing.

RESULTS

In Group 1, the combination of skin tapes and tissue adhesive provided the strongest immediate wound closure. Average mean force for disruption immediately after wound repair was 19.9 lbs. for the tapes and tissue adhesive group compared to 9.6 lbs. for adhesive alone and 8.9 lbs. for tapes alone. The difference in mean force for combination repair vs. tapes alone was 10.3 lbs. (95% CI 4.1, 16.7), and combination vs. adhesive alone was 10.9 lbs. (95% CI 4.7, 17.3). In Group 2, the mean force required for laceration disruption for those repaired with both tape and tissue adhesive was 188.9 lbs. The mean force until wound disruption for tape only was 165.6 lbs., and the mean force until wound disruption for tissue adhesive alone was 118.9 lbs. The difference in mean force required for wound disruption for those repaired with adhesive alone vs. combination repair is 66.5 lbs. (95% CI 21.2, 111.9). The difference in mean force required for wound disruption between the other two groups was not statistically significant.

CONCLUSIONS

This study demonstrates that the combination of skin tapes and tissue adhesive provides superior immediate wound closure strength to either of these methods alone in a porcine model.

Comparison of the Force Required for Dislodgement Between Secured and Unsecured Airways

INTRODUCTION

Airway device placement and maintenance are of utmost importance when managing critically ill patients. The best method to secure airway devices is currently unknown.

STUDY OBJECTIVE

We sought to determine the force required to dislodge 4 types of airways with and without airway securing devices.

METHODS

We performed a prospective study using 4 commonly used airway devices (endotracheal tube [ETT], laryngeal mask airway [LMA], King laryngeal tube [King], and iGel) performed on 5 different mannequin models. All devices were removed twice per mannequin in random order, once unsecured and once secured as per manufacturers' recommendations; Thomas Tube Holder (Laerdal, Stavanger, Norway) for ETT, LMA, and King; custom tube holder for iGel. A digital force measuring device was attached to the exposed end of the airway device and gradually pulled vertically and perpendicular to the mannequin until the tube had been dislodged, defined as at least 4 cm of movement. Dislodgement force was reported as the maximum force recorded during dislodgement. We compared the relative difference in the secured and unsecured force for each device and between devices using a random-effects regression model accounting for variability in the manikins.

RESULTS

The median dislodgment forces (interquartile range [IQR]) in pounds for each secured device were: ETT 13.3 (11.6, 14.1), LMA 16.6 (13.9, 18.3), King 21.7 (16.9, 25.1), and iGel 8 (6.8, 8.3). The median dislodgement forces for each unsecured device were: ETT 4.5 (4.3, 5), LMA 8.4 (6.8, 10.7), King 10.6 (8.2, 11.5), and iGel 3.9 (3.2, 4.2). The relative difference in dislodgement forces (95% confidence intervals) were higher for each device when secured: ETT 8.6 (6.2 to 11), LMA 8.8 (4.6 to 13), King 12.1 (7.2 to 16.6), iGel 4 (1.1 to 6.9). When compared to secured ETT, the King required greater dislodgement force (relative difference 8.6 [4.5-12.7]). The secured iGel required less force than the secured ETT (relative difference -4.8 [-8.9 to -0.8]).

CONCLUSION

Compared with a secured device, an unsecured airway device requires only half the force to cause airway dislodgement. The secured King had the highest dislodgement force relative to the other studied devices.

A Noninvasive System for Biomechanical Properties Measurement of Soft Tissue

A device for measuring the biomechanical properties of soft tissue via palpation was developed. The device, which is worn by a medical professional, incorporates sensors that collect data on the position of the users’ hand in three-dimensional space as well as the force that the user applies to the tissue. The depth of palpation, the force used to achieve that depth, and the thickness of the tissue obtained from a computed tomography scan of the abdomen were used to calculate the stiffness properties of each individual layer of tissue. Some experimental data obtained by curve fitting force-displacement curves are presented. The data obtained from this experiment illustrates the potential of this device to be used for accurate measurement of soft tissue properties.

The effects of a mandatory motorcycle helmet law on helmet use and injury patterns among motorcyclist fatalities

BACKGROUND

The National Highway Traffic Safety Administration (NHTSA) has found that motorcycle helmets are 37% effective in preventing death and 65% effective in preventing brain injuries in a crash. Unfortunately, in 1995 Congress lifted federal sanctions against states without helmet laws and since then there have been a number of primary motorcycle helmet laws repealed or weakened. More lives could be saved and serious injuries avoided if there was increased helmet use throughout the United States.

METHODS

This study analyzed helmet use and injury patterns among motorcycle riders in the United States involved in fatal crashes from 1995 through 2003 and compared the results between states with and without a primary helmet law. Age, sex, injury severity and helmet use are some of the variables obtained from the Fatality Analysis Reporting System (FARS).

RESULTS

In the 20 states and the District of Columbia, which currently have a primary helmet law, 84.0% of fatally injured riders were wearing a helmet. In the 27 states with a secondary helmet law, 36.2% of fatalities used a helmet, and in the remaining three states with no law at all, helmet use dropped to 17.6%. In the two states (Arkansas and Texas) that changed from a primary helmet law to a secondary helmet law in 1997, helmet use decreased from 78.2% in 1996 to 31.7% in 2000.

CONCLUSION

If all states were to enact a primary motorcycle helmet law, helmet use would dramatically increase while decreasing the number of motorcyclist head injuries and fatalities.

IMPACT ON INDUSTRY

The results of this study will hopefully persuade law makers to enact primary helmet laws in all states throughout the nation. Helmet manufacturers can use this data to design more comfortable helmets while also improving upon the protective qualities of these safety devices.

The safest seat: effect of seating position on occupant mortality

INTRODUCTION

This study investigated the survival rates of occupants of passenger cars involved in a fatal crash between 2000 and 2003.

METHODS

The information from every fatal crash in the United States between 2000 and 2003 was analyzed. Variables such as seat position, point of impact, rollover, restraint use, vehicle type, vehicle weight, occupant age, and injury severity were extracted from the Fatality Analysis Reporting System (FARS). Univariate and a full logistic multivariate model analyses were performed.

RESULTS

The data show that the rear middle seat is safer than any other occupant position when involved in a fatal crash. Overall, the rear (2(nd) row) seating positions have a 29.1% (Univariate Analysis, p<.0001, OR 1.29, 95% CI 1.22 - 1.37) increased odds of survival over the first row seating positions and the rear middle seat has a 25% (Univariate Analysis, p<.0001, OR 1.25, 95% CI 1.17 - 1.34) increased odds of survival over the other rear seat positions. After correcting for potential confounders, occupants of the rear middle seat have a 13% (Logistic Regression, p<.001, 95% CI 1.02 - 1.26) increased chance of survival when involved in a crash with a fatality than occupants in other rear seats.

CONCLUSION

This study has shown that the safest position for any occupant involved in a motor-vehicle crash is the rear middle seat.

IMPACT ON INDUSTRY

The results of this research may impact how automobile manufacturers look at future rear middle seat designs. If the rear seat was to be designed exactly like its outboard counterparts (headrest, armrests, lap and shoulder belt, etc.) people may choose to sit on it more often rather than waiting to use it out of necessity due to multiple rear seat occupants.

Extubation Force: Tape Versus Endotracheal Tube Holders

STUDY OBJECTIVE

Tape is the standard method for securing endotracheal tubes to prevent extubation. This study examines the force required to extubate endotracheal tubes from cadavers with either tape or one of 4 commercially available endotracheal tube holders.

METHODS

Newly deceased, unembalmed cadavers were intubated with standard tracheal intubation techniques. The endotracheal tube was secured with either tape or one of 4 commercially available endotracheal tube holders. The endotracheal tube was then connected to a force-measuring device and pulled until the cuff was removed from the trachea. The largest force recorded on the device was then marked as the "extubation force" for that trial.

RESULTS

When tape was used to secure the endotracheal tube, it required a significantly larger force to extubate than 3 of 4 off-the-shelf endotracheal tube holders. Only the Thomas Tube Holder secured the endotracheal tube better than tape.

CONCLUSION

Although the Thomas Tube Holder had the greatest holding force in this study, tape was shown to be the least expensive and outperformed 3 other commercially available devices used to secure endotracheal tubes.

A multicenter comparison of tap water versus sterile saline for wound irrigation

OBJECTIVES

To compare wound infection rates for irrigation with tap water versus sterile saline before closure of wounds in the emergency department.

METHODS

The study was a multicenter, prospective, randomized trial conducted at two Level 1 urban hospitals and a suburban community hospital. Subjects were a convenience sample of adults presenting with acute simple lacerations requiring sutures or staples. Subjects were randomized to irrigation in a sink with tap water or with normal saline using a sterile syringe. Wounds were closed in the standard fashion. Subjects were asked to return to the emergency department for suture removal. Those who did not return were contacted by telephone. Wounds were considered infected if there was early removal of sutures or staples, if there was irrigation and drainage of the wound, or if the subject needed to be placed on antibiotics. Equivalence of the groups was met if there was less than a doubling of the infection rate.

RESULTS

A total of 715 subjects were enrolled in the study. Follow-up data were obtained on 634 (88%) of enrolled subjects. Twelve (4%) of the 300 subjects in the tap water group had wound infections, compared with 11 (3.3%) of the 334 subjects in the saline group. The relative risk was 1.21 (95% confidence interval = 0.5 to 2.7).

CONCLUSIONS

Equivalent rates of wound infection were found using either irrigant. The results of this multicenter trial evaluating tap water as an irrigant agree with those from previous single institution trials.

Consultation times in emergency telemedicine using realtime videoconferencing

We reviewed 2135 consecutive emergency teleconsultations, which were received at an academic emergency department from state correctional facilities. During the 52-week study period, an average of 5.8 video-consultations per day were performed. A total of 1522 consultations (71%) had complete start and end consultation times, and were included in the analysis. Of these, 923 were managed primarily by emergency medicine residents and physician assistants, while the remaining 599 were managed by attending physicians alone. Following consultation, the disposition of the patients included 940 who were transported to the emergency department, 351 who were discharged to the general facility population and 193 who were admitted to the local infirmary. Overall, 38% of patients avoided a journey to the emergency department. The average consultation time was 17 min (95% confidence interval [CI], 10-24). The average consultation time for residents and physician assistants was 16 min (95% CI, 8-24) and it was 19 min (95% CI, 11-27) for attending physicians. Consultation time for patients not transported to the emergency room was 21 min (95% CI, 13-29), while for patients transferred to an emergency department, consultation time was 15 min (95% CI, 9-21). These results may assist in planning the workforce requirements for emergency department-based telemedicine services.

The effect of unrestrained rear-seat passengers on driver mortality

BACKGROUND

It is well documented that seat belt usage effectively reduces the severity of motor vehicle occupant injuries and fatalities in roadway crashes. This research examines how the presence of an unrestrained rear-seat passenger seated directly behind an airbag and/or belt-restrained driver affects the driver's risk of injury in two different idealized crash scenarios. Empirical data used in the study was obtained from four sled tests conducted with various size Hybrid III crash test dummies.

METHODS

Three tests simulated a frontal (head-on) impact between two vehicles. The first established the baseline condition: a driver dummy restrained by a belt and an airbag system, with an identical belt-restrained dummy seated directly behind. The other two frontal-mode tests involved different size driver dummies restrained in the same manner, with different size unrestrained dummies behind them. A fourth test featured an angled driver-side impact crash with a restrained driver and unrestrained rear seat passenger.

RESULTS

In both of the latter cases the driver incurred a high likelihood of severe head and chest injuries relative to that inferred in the baseline exposure. The last test featured two identical dummies in a simulated lateral (driver-side) inter-vehicular impact using a belt-restrained (only) driver and an unrestrained rear-seat passenger. Driver mortality was not significantly affected in this configuration.

CONCLUSION

Unrestrained rear-seat passengers place themselves as well as their driver at great risk of serious injury when involved in a head-on crash.

Influence of the unbelted rear-seat passenger on driver mortality: "the backseat bullet"

OBJECTIVES

This study examined whether unrestrained left rear-seat passengers increase the risk of death of belted drivers involved in serious crashes with at least one fatality.

METHODS

The information from every fatal crash in the United States between 1995 and 2001 was analyzed. Variables such as point of impact, restraint use, seat position, vehicle type, occupant age, gender, and injury severity were extracted from the Fatality Analysis Reporting System.

RESULTS

The odds of death for a belted driver seated directly in front of an unrestrained passenger in a serious head-on crash was 2.27 times higher (95% confidence interval [CI] = 1.94 to 2.66) than if seated in front of a restrained passenger. In contrast, a belted driver seated in front of an unrestrained passenger in a driver-side lateral-impact crash had no increase in mortality over a driver with a restrained rear-seat passenger (odds ratio, 0.8; 95% CI = 0.6 to 1.06). Logistic regression showed that passenger restraint, point of impact, vehicle type, passenger age, and driver age had a statistically significant influence on the outcome (death) of belted drivers. Adjusting for confounders (other than point of impact), the odds of fatality for a belted driver in a head-on crash was 2.28 times greater (95% CI = 1.93 to 2.7) with an unbelted rear-seat passenger. The unbelted rear-seat passenger also had an increased risk of death (odds ratio, 2.71; 95% CI = 2.44 to 3.01) when compared with restrained rear-seat passengers.

CONCLUSIONS

Unrestrained rear-seat passengers place themselves and their driver at great risk of fatal injury when involved in a crash.

Seat Belt Use By Police: Should They Click It?

BACKGROUND

Motor vehicle crashes are a leading cause of mortality in the United States, although seat belts significantly reduce the risk of death. Police officers do not always wear a seat belt. A retrospective study was conducted on all crashes that involved marked police vehicles in the United States and included a death in any of the involved vehicles.

METHODS

For the years 1997 through 2001, crash data were collected and analyzed from the Fatality Analysis Reporting System that included an isolated or multiple vehicle crash with a marked police vehicle and a resulting death in any of the involved vehicles. Motorcycle, aircraft, and undercover police crashes were excluded from this study. Only the occupants of the police vehicle involved in the crash were included in the study. In addition, crashes involving police vehicles where the status of seat belt use by the occupants of the police vehicle was unknown were also excluded.

RESULTS

When the crashes occurred, 59.9% of the officers were responding to nonemergency calls, 79.8% of the occupants were wearing their seat belts, and 79.5% survived. Of the 104 occupants that were not belted, 42 (40.4%) died in the crash, compared with 64 (15.5%) of the 412 belted occupants (risk ratio, 2.6; odds ratio, 3.7).

CONCLUSION

The risk of death was 2.6 times higher for unbelted occupants of police vehicles than for belted occupants in our study population. In addition, seat belt use was not statistically related to emergency versus nonemergency calls.

Utilization of virtual reality for endotracheal intubation training

Tracheal intubation is performed for urgent airway control in injured patients. Current methods of training include working on cadavers and manikins, which lack the realism of a living human being. Work in this field has been limited due to the complex nature of simulating in real-time, the interactive forces and deformations which occur during an actual patient intubation. This study addressed the issue of intubation training in an attempt to bridge the gap between actual and virtual patient scenarios. The haptic device along with the real-time performance of the simulator give it both visual and physical realism. The three-dimensional viewing and interaction available through virtual reality make it possible for physicians, pre-hospital personnel and students to practice many endotracheal intubations without ever touching a patient. The ability for a medical professional to practice a procedure multiple times prior to performing it on a patient will both enhance the skill of the individual while reducing the risk to the patient.

The success of emergency telemedicine at the State University of New York at Buffalo

The Telemedicine Program at the State University of New York at Buffalo, School of Medicine, and the Erie County Medical Center (UB/ECMC) represents a "quiet success story" for telemedicine development. Though a relatively young program starting in 1992, it demonstrates steady and consistent progress in the areas of clinical services, education and research as it continues to develop as a comprehensive university telemedicine program. The Emergency Telemedicine program provided 2,294 consultations in 2001. Other services included clinics in Gastroenterology, Infectious Disease (HIV/AIDS), Psychiatry, Orthopedic Hand Surgery, Dermatology, and Neurology. The UB/ECMC program has sponsored regular education activities with a focus on internet protocol (IP) videoconferencing for grand rounds in emergency medicine and traffic injury research, nursing education, distance precepting of nurse practitioner students on clinical rotations, Megaconference I and II presentations, and the continuing exploration of advanced tools for educational presentation over the internet. The program's research activities have focused on portable, roll-about telemedicine systems and virtual palpation using a data glove.

Predicted utilization of emergency medical services telemedicine in decreasing ambulance transports

OBJECTIVE

To determine predicted utilization, decrease in ambulance transports, and target population for emergency medical services (EMS) if telemedicine capabilities were available to the medic units in the field.

METHODS

A retrospective chart review of 345 consecutive ambulance transports to four hospitals (Level I urban trauma center, urban tertiary care center, children's hospital and suburban community hospital) was performed by a panel of three board-certified emergency medicine physicians experienced and credentialed in emergency telemedicine. They independently reviewed the emergency department (ED) and EMS records and were asked to determine whether patients required ambulance transport for evaluation or whether disposition could be made following paramedic and emergency physician assessment via telemedicine. A five-point Likert scale was used to grade feasibility of telemedicine disposition (definitely yes, probably yes, maybe, probably no, definitely no). Other variables analyzed included age, sex, race, chief complaint, phone, private medical doctor, and call location by patient zip code, call site, and receiving hospital.

RESULTS

In 14.7% of cases (6% definitely yes and 8.7% probably yes), disposition could be made without transport using telemedicine. The age range for eliminating transport was 2 weeks through 92 years, with mean age of 26.6 years. Under the age of 50 years, 46 out of 238 patients (19.3%) could have possibly been managed by telemedicine.

CONCLUSION

Use of EMS telemedicine could result in an approximately 15% decrease in ambulance transports when it alone is added to the prehospital care provider's armamentarium. Emphasis for implementation should be placed on younger patients and an identified subset of chief complaints conducive to management using telemedicine.

Vehicle weight and fatality risk for sport utility vehicle-versus-passenger car crashes

BACKGROUND

This study examines whether mortality is greater in sport utility vehicles (SUVs) or passenger cars when these vehicles collide in a head-on crash.

METHODS

This study analyzed the effect of vehicle weight in head-on crashes between passenger cars and SUVs between 1994 and 1999. Variables such as location of impact, safety belt use, vehicle weight, vehicle type, number of occupants, and number of fatalities were extracted from the Fatality Analysis Reporting System.

RESULTS

Belted occupants of passenger cars involved in a fatal head-on collision with an SUV had a higher fatality rate (total deaths per vehicle type/total occupants per vehicle type) than belted occupants of the SUV (56.3% of passenger car occupants vs. 17.6% of SUV occupants). The difference in fatality rates is reduced when the weight of the passenger car is equivalent to the weight of the SUV but is still significant (45.6% of passenger car occupants vs. 26.5% of SUV occupants). In the 57 crashes where the passenger cars outweighed the SUVs by an average of 234 lb, the occupants of the cars still had a higher fatality rate than occupants of the SUVs (40.1% of passenger car occupants vs. 24.4% of SUV occupants).

CONCLUSION

Occupants of passenger cars have a higher risk of fatality than occupants of SUVs in car-versus-SUV head-on crashes. Vehicle differential weight plays an important role in determining the safety of occupants involved in these crashes, but safety cannot be evaluated on the basis of vehicle weight alone. Other factors such as mismatches in vehicle design and structural load path must also be considered.

An analysis of race and demographic factors among motor vehicle fatalities

BACKGROUND

According to the National Highway Traffic Safety Administration, from 1982 through 1995 safety belts are estimated to have saved 74,769 lives. Even more lives could be saved and serious injuries avoided if there was increased seat belt use in the United States.

METHODS

This study analyzed safety belt use among drivers and passengers involved in fatal motor vehicle crashes from 1993 through 1995. Age, sex, race, safety belt use, and position in the vehicle were the demographic factors obtained from both the Fatality Analysis Reporting System and the National Highway Traffic Safety Administration.

RESULTS

Overall, safety belt use increased by an average of 1.3% per year for the entire study population. Forward logistic regression identified age, female gender, Caucasian race, and driver as significant predictors of safety belt use.

CONCLUSION

This study has identified younger males, African Americans, and passengers as high-risk populations for nonuse of safety belts among fatal motor vehicle crashes. These high-risk populations should be educated regarding the importance of safety belt use.

A virtual environment for esophageal intubation training

Esophageal intubations are performed for urgent airway control in injured patients. Current methods of training include working on cadavers and mannequins, which lack the realism of a living human being. Work in this field has been limited due to the complex nature of simulating in real-time the interactive forces and deformations which occur during an actual patient intubation. This study addressed the issue of intubation training in an attempt to bridge the gap between actual and virtual patient scenarios. The two haptic devices along with the real-time performance of the simulator give it both visual and physical realism. The three dimensional viewing and interaction available through virtual reality make it possible for physicians, pre-hospital personnel and students to practice many esophageal intubations without ever touching a patient. The ability for a medical professional to practice a procedure multiple times prior to performing it on a patient will both enhance the skill of the individual while reducing the risk to the patient.

A telemedicine model for emergency care in a short-term correctional facility

The primary objectives of this research were to determine the effectiveness of a personal computer-based telemedicine system for semi- and nonurgent complaints at a short-term correctional facility and to evaluate the system as a potential model for providing emergency care to remote locations. We performed a retrospective review of medical records of patients referred to the emergency department in person or via telemedicine during a 12-month period. The data included system utilization, chief complaints, physical examination, diagnostic testing, disposition, and outcomes in patients evaluated via telemedicine. Also identified were nursing diagnostic and procedure skills associated with successful evaluation via telemedicine. A total of 530 emergency care records were reviewed with 126 telemedicine consultations performed. Eighty-one of 126 (64%) telemedicine patients remained at the facility following consultation with the remaining 45 (36%) being transported to the emergency department. Rates of return to the emergency department within 7 days following consultation were comparable, patient acceptance and satisfaction was high, and there were no untoward outcomes in the group. Average total time of telemedicine consultation was 30 minutes versus a 2-hour and 45-minutes turnaround time for an emergency department evaluation. A variety of emergency complaints were managed effectively using relatively low-cost computer-based telemedicine technology, thereby eliminating the need for transportation of the patient to the emergency department. This system provides an emergency physician-nurse model for conduction limited emergency care in remote settings.

Material property determination of sub-surface objects in a viscoelastic environment

Modeling human organs and soft tissue or anatomic regions for the purpose of medical training and simulation is a relatively new area. The data presented here is the groundwork for our ongoing development of a real-time haptic virtual environment for abdominal soft tissue palpation. The purpose of modeling the human abdomen is twofold. First, to provide a mathematical description of soft tissue and organs and second, to simulate the behavior of realistic interactions in real-time within a virtual environment. We have developed a, non-invasive, system that will allow us to determine mathematical functions that model the deformation of individual layers of soft tissue within the human abdomen. This system has been tested, experimentally, with a viscoelastic polyester foam model. We have been able to determine the stiffness and force/displacement function of an object beneath two layers of foam having different material characteristics. These experimental results correlate well with known polyester foam material characteristics. In general, the calculated stiffness constants were within 5% of the actual value. The data presented in this study shows that this system may be a viable tool for accurate measurement of human soft tissue properties and behavioral response to palpation.

Comparison of staples versus sutures in the repair of penetrating cardiac wounds

BACKGROUND

Several literature reports advocate the use of skin staplers for repair of penetrating cardiac wounds during emergency thoracotomy. Our study goal was to objectively determine if stapling is a more efficient method of closure compared with suturing without compromising the strength of the repair.

METHODS

This randomized, nonblinded study was conducted in a swine model. A total of four incisions, two per ventricle, were made in each animal. The 2-cm full-thickness incisions were repaired with either sutures or staples, and the time required to close each wound was recorded. After wound repair, the animals were killed. The four wounds were isolated by removing 4.0-cm strips of myocardium oriented perpendicular to the incision. Each strip was then placed on a tensile force testing machine, and the breaking strength of the sutures and staples was measured.

RESULTS

The tensile force test showed that stapled and sutured wounds have equivalent mechanical strength. The mean time of closure for stapled wounds was substantially less than that for sutured wounds.

CONCLUSION

In this swine model, stapling took significantly less time and had equal mechanical strength compared with suturing for repair of penetrating cardiac wounds. Stapling during emergent resuscitation may be preferable to suturing.

Wound irrigation with tap water

OBJECTIVE

The study hypothesis was that irrigation with tap water is as efficacious as irrigation with sterile saline in removing bacteria from simple lacerations in preparation for wound closure.

METHODS

The study was conducted in a laboratory rat model previously described in the literature for evaluating wound irrigation techniques. The study used a randomized, blinded crossover design using 10 animals. Two full-thickness skin lacerations were made on each animal and each wound was inoculated with standardized concentrations of a Staphylococcus aureus broth. Wounds were irrigated for 4 minutes with normal saline from a syringe or 4 minutes with tap water from a faucet. Tissue specimens were sampled from each laceration prior to and following irrigation. Bacterial counts per gram of tissue were determined for each specimen and compared pre- and postirrigation.

RESULTS

Preirrigation bacterial counts were not significantly different for saline vs tap water specimens. The wounds irrigated with saline had a mean reduction in bacterial count of 54.7% (SD=+/-28%), while the wounds irrigated with tap water had a mean reduction in bacterial count of 80.6% (SD=+/-20%) (p < 0.05, 2-tailed, paired t-test).

CONCLUSIONS

In this animal model, bacterial decontamination of simple lacerations was not compromised, and was actually improved using tap water irrigation. This is most likely due to the mechanical differences in the types of irrigation. In certain instances, such as with upper-extremity lacerations, tap water irrigation would likely be cheaper and less labor-intensive than irrigation with normal saline from a syringe.

Comparison of normal saline with tap water for wound irrigation

This study compared irrigation with tap water versus saline for removing bacteria from simple skin lacerations. The study was conducted in an animal model with a randomized, nonblinded crossover design using 10 500-g laboratory rats. Two full-thickness skin lacerations were made on each animal and inoculated with standardized concentrations of Staphylococcus aureus broth. Tissue specimens were removed before and after irrigation with 250 cc of either normal saline from a sterile syringe or water from a faucet. Bacterial counts were determined for each specimen and compared before and after irrigation. There was a mean reduction in bacterial counts of 81.6% with saline and 65.3% with tap water (P = .34). One tap water specimen had markedly aberrant bacterial counts compared with others. Excluding this specimen, the mean reduction for tap water was 80.2%. In this model, reduction in bacterial contamination of simple lacerations was not different comparing tap water with normal saline as an irrigant.