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)