Management of traumatic wounds in the Emergency Department: position paper from the Academy of Emergency Medicine and Care (AcEMC) and the World Society of Emergency Surgery (WSES)

World Journal of Emergency Surgery, Jun 2016

Traumatic wounds are one of the most common problems leading people to the Emergency Department (ED), accounting for approximately 5,4 % of all the visits, and up to 24 % of all the medical lawsuits. In order to provide a standardized method for wound management in the ED, we have organized a workshop, involving several Italian and European experts. Later, all the discussed statements have been submitted for external validation to a multidisciplinary expert team, based on the so called Delphi method. Eight main statements have been established, each of them comprising different issues, covering the fields of wound classification, infectious risk stratification, tetanus and rabies prophylaxis, wound cleansing, pain management, and suture. Here we present the results of this work, shared by the Academy of Emergency Medicine and Care (AcEMC), and the World Society of Emergency Surgery (WSES).

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Management of traumatic wounds in the Emergency Department: position paper from the Academy of Emergency Medicine and Care (AcEMC) and the World Society of Emergency Surgery (WSES)

Prevaldi et al. World Journal of Emergency Surgery Management of traumatic wounds in the Emergency Department: position paper from the Academy of Emergency Medicine and Care (AcEMC) and the World Society of Emergency Surgery (WSES) Carolina Prevaldi 0 3 Ciro Paolillo 2 Carlo Locatelli 1 Giorgio Ricci 7 Fausto Catena 6 Luca Ansaloni 5 Gianfranco Cervellin 4 0 Emergency Department, Hospital of San Donà di Piave VE , Parma , Italy 1 Institute of Toxicology, IRCCS Fondazione Maugeri Pavia , Parma , Italy 2 Emergency Department, Academic Hospital of Udine , Parma , Italy 3 Emergency Department, Hospital of San Donà di Piave VE , Parma , Italy 4 Emergency Department, Academic Hospital of Parma , Parma , Italy 5 Emergency surgery, Hospital of Bergamo , Parma , Italy 6 Emergency Surgery, Academic Hospital of Parma , Parma , Italy 7 Emergency Deparment, Academic Hospital of Verona , Parma , Italy Traumatic wounds are one of the most common problems leading people to the Emergency Department (ED), accounting for approximately 5,4 % of all the visits, and up to 24 % of all the medical lawsuits. In order to provide a standardized method for wound management in the ED, we have organized a workshop, involving several Italian and European experts. Later, all the discussed statements have been submitted for external validation to a multidisciplinary expert team, based on the so called Delphi method. Eight main statements have been established, each of them comprising different issues, covering the fields of wound classification, infectious risk stratification, tetanus and rabies prophylaxis, wound cleansing, pain management, and suture. Here we present the results of this work, shared by the Academy of Emergency Medicine and Care (AcEMC), and the World Society of Emergency Surgery (WSES). Traumatic wounds; Infection; Foreign body; Tetanus; Rabies; Suture Introduction Traumatic wounds are one of the most common prob lems leading people to the Emergency Department (ED), and account for approximately 5,4 % of all the visits [ 1, 2 ]. The ED represents the most available facility for wound care, due to the 24-h free access and the decreasing primary care availability. As such, provision for effective and safe wound care will continue to be a priority for Emergency Physicians (EPs). Moreover, traumatic wounds have been historically a major source of litigation against EPs, accounting for up to 24 % of all the medical lawsuits, mainly due to missed identification and treatment of tendon or nerve injuries, or to infection and/or presence of foreign bodies [2]. Hence, although most wounds will heal without any treatment, a prompt and careful repair of these injuries reduces infection and scarring, so improving the patient satisfaction and avoiding significant additional costs [ 1 ]. However, in current clinical practice several different approaches to traumatic wounds are still practiced, due to cultural gaps, myths and local traditions. One of the specific goals of the third European Union (EU) program in the health care area, years 2014–2020, is to improve access to a skilled, standardized and safe health care for EU citizens, thus improving the quality of health care and patient safety. According to these objectives we have organized a workshop aimed to share knowledge and experiences in the field of wound care, involving several Italian and European experts. The workshop was settled in Venice, in October 2014. Later, all the discussed statements have been submitted for external validation to a multidisciplinary expert team, as described in the methods. On the basis of the results of this complex and time-consuming work, the Academy of Emergency Medicine and Care (AcEMC), and the World Society of Emergency Surgery (WSES) have decided to build, write and spread a multidisciplinary position statement on the management of traumatic wounds in the ED. The main purposes of the present work are: To assess the current scientific evidence on the subject. To draw up a multidisciplinary consensus document aimed to establish a standardized and correct method of management of traumatic wounds in the ED. To help clinicians in the clinical risk stratification, to improve diagnostic and therapeutic appropriateness as well as the cost-benefit ratio, to reduce clinical errors, and to increase patient satisfaction. To provide an opportunity for research and educational initiative. Methods We have decided to use a modified Delphi method, that is a structured communication technique, originally developed as a systematic, interactive forecasting method which relies on a panel of experts [ 3, 4 ]. The experts answer to one ore more questionnaires in two or more rounds. After each round, a facilitator provides an anonymous summary of the experts’ forecasts from the previous round as well as the reasons they provided for their judgments. Thus, experts are encouraged to revise their earlier answers in light of the replies o (...truncated)


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Carolina Prevaldi, Ciro Paolillo, Carlo Locatelli, Giorgio Ricci, Fausto Catena, Luca Ansaloni, Gianfranco Cervellin. Management of traumatic wounds in the Emergency Department: position paper from the Academy of Emergency Medicine and Care (AcEMC) and the World Society of Emergency Surgery (WSES), World Journal of Emergency Surgery, 2016, pp. 30, 11, DOI: 10.1186/s13017-016-0084-3