National trends in ED lacerations between 1992 and 2002

Objective National estimates of the number of lacerations are based on the number of wounds cared for in the emergency department (ED). However, this number includes wounds other than lacerations. We estimated the number and characteristics of lacerations treated in the United States between 1992 and 2002. Methods The design used was secondary analysis of National Hospital Ambulatory Medical Care Survey (a weighted sample of ED encounters). Encounters with a laceration recorded as 1 of the 3 diagnosis codes (870-897) of the International Classification of Diseases, Ninth Revision, Clinical Modification for the visit were included. Data collection included demographics, wound location, insurance status, procedures performed, type of practitioner, and pain severity. For data analysis, the National Hospital Ambulatory Medical Care Survey databases for 1992 to 2002 were downloaded from its Web site and imported into SPSS 12.0 (SPSS, Chicago, Ill) for analysis. National estimates were obtained using assigned patient visit weights. Descriptive statistics were calculated, and group comparisons were performed with χ2 tests using unweighted data. Rates were calculated using population data from the US census. Results There were 300 715 patient encounters sampled from nearly 400 EDs resulting in an estimated 1.08 billion ED visits between 1992 and 2002. In the sample, 24 755 patients (8.2%) had lacerations resulting in an estimated 90 million lacerations. Although the number of total ED visits increased annually during the study period (from 89.8 to 110.15 million), the number of lacerations declined (from 9.35 to 7.27 million). Lacerations were distributed on the upper extremity (35%), face (28%), trunk (14.5%), lower extremity (12.5%), and head and neck (10%). In 2002, about two thirds of the patients with a laceration were men, one third were children, and more than three fourths were white. Facial lacerations were more common in children (43% vs 20%; P < .01), whereas upper extremity lacerations were more common in adults (48% vs 20%, P < .001). The number of visits for lacerations was greatest on weekends, during the spring and summer, and between noon and 10 pm. Work-related injuries accounted for 11% of lacerations. Conclusions Despite an increase in the total number of ED visits over the last decade, the number of lacerations has declined, as is less than previously estimated.