Cosmetic outcome of scalp wound closure with staples in the pediatric emergency department: a prospective, randomized trial

Abu N G A Khan, Peter S Dayan, Steven Miller, Michael Rosen, David H Rubin
Pediatric Emergency Care 2002, 18 (3): 171-3

OBJECTIVE: The purpose of this study is to compare the cosmetic outcome of scalp wound closure with staples to traditional skin sutures.

METHODS: A prospective, randomized trial was conducted using a convenience sample of children (aged 1-16 y) with simple scalp lacerations admitted to the pediatric emergency department. After parental consent was obtained, patients were randomly assigned to either a stapling or suturing procedure. A trained attending physician completed the procedure following a standard protocol. Based on previously published data, a sample size of 18 patients per group was calculated to give 85% power to detect a 10% difference on a visual analogue scale (VAS) score (two-sided alpha 0.05). Initial outcome of wound healing at 7 to 10 days and final cosmetic outcome after 6 to 18 months were estimated using a VAS. Cosmetic outcome was assessed by a physician blinded to the procedure. Data were analyzed using SPSS (Version 8.02; SPSS Inc., Chicago, IL). The VAS scores for the two treatment groups were compared using the two-tailed Student t test. Analysis of age, race, mode of injury, time interval, and size of the wound were performed to estimate the strength of the association of VAS score with the treatment, adjusted for the covariates.

RESULTS: A total of 42 patients were enrolled. Of the 42, 38 (90.5%) finished the initial follow-up and 31 of those 38 (81.6%) finished the final follow-up. There were no significant demographic differences between groups at recruitment and first follow-up. Among those patients who completed the final follow-up, 15 underwent stapling, and 16 underwent suturing. There were no significant demographic or baseline differences between the groups. Procedure time was significantly lower in the stapling group (P = 0.001). Final follow-up evaluations were completed in 12 +/- 4 months. The mean VAS scores at first and final follow-up were 78.75 +/- 16.16 and 96.31 +/- 8.06 for the suturing group and 86.67 +/- 9.76 and 97 +/- 7.02 for the stapling group (P = 0.17). There remained no significant difference in the final follow-up VAS score between groups when adjusted for covariates.

CONCLUSION: Stapling appears to be a fast and cosmetically acceptable alternative to suturing for simple scalp lacerations.

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