Efficacy of nurses suturing pediatric dermal lacerations in an emergency department

Study objective: To assess the efficacy of nurses suturing pediatric dermal lacerations in an emergency department. Design: Prospective study. Setting: Pediatric ED. Participants: Suturing nurses completed a comprehensivetraining program provided by physicians at our institution and at a national wound management workshop; both included instruction in wound assessment, preparation, anesthesia, repair, and care after repair. A survey of physician and parent satisfaction with wound repair and for wound healing complications was performed at the time of suture removal in 61 children whose dermal laceration was repaired by suturing nurses. Results: The laceration was located on the face in 40 patients,the scalp in 14, and an extremity in 7. A total of 343 sutures was required (18 lacerations required a layered closure). Pediatricians graded wound repair as "very good" in 32 cases (53%) and "excellent" in 29 cases (47%). Parents rated themselves as "very satisfied" with the wound repair procedure in 60 cases (98%) and with the wound repair outcome in 59 cases (97%). There were no wound-healing complications. Suturing nurses took a total of 72 hours to repair lacerations. In comparison, of 20 lacerations repaired by an ED attending physician, 11 (55%) were graded as "excellent" and 9 (45%) as "very good", with no wound-healing complications (P=NS). Conclusion: Nurses who complete a standardized trainingprogram in wound management and repair are capable of providing high-quality, definitive care for children with dermal lacerations, thus allowing physicians to use their time more effectively in managing general patient care in the ED.