Is time to closure a factor in the occurrence of infection in traumatic wounds? A prospective cohort study in a Dutch level 1 trauma centre

M.T.M. van den Baar, Jacobus Adrianus Maria van der Palen, M.I. Vroon, P. Bertelink, Ron Hendrix

Research output: Contribution to journalArticleAcademicpeer-review

17 Citations (Scopus)

Abstract

Background The dogma that traumatic wounds should not be sutured after 6 h is based on an animal experiment by P L Friedrich in 1898. There is no adequately powered prospective study on this cut-off of 6 h to confirm or disprove the dogma. The aim of this study was to provide evidence against the dogma that wounds should be sutured within 6 h after trauma. Method 425 patients were included in a prospective cohort study. Patients' wounds were closed, independent of time after trauma. All patients were seen after 7–10 days for removal of stitches and wound control on infection. Results Of the 425 patients, 17 were lost to follow-up. Of the remaining 408 patients, 45 had wounds older than 6 h after trauma. At follow-up 372 patients (91%) had no infection and 36 patients had redness of the suture sites or worse. 11 patients (2.7%) had general redness or pus. Of those with a wound older than 6 h, three of 45 (6.7%) wounds were infected, versus 30 of 363 (9.1%) in wounds younger than 6 h (p=0.59). Conclusion In everyday practice wounds are sutured regardless of elapsed time. Here an attempt was made to present the evidence for this daily routine, contrary to Friedrich's Dogma.
Original languageEnglish
Pages (from-to)540-543
JournalEmergency medicine journal
Volume27
DOIs
Publication statusPublished - 2010

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Trauma Centers
Cohort Studies
Prospective Studies
Wounds and Injuries
Infection
Suppuration
Lost to Follow-Up
Infection Control
Sutures

Keywords

  • METIS-272827

Cite this

@article{282861bc9d734fcc9d89d98abf7f714a,
title = "Is time to closure a factor in the occurrence of infection in traumatic wounds? A prospective cohort study in a Dutch level 1 trauma centre",
abstract = "Background The dogma that traumatic wounds should not be sutured after 6 h is based on an animal experiment by P L Friedrich in 1898. There is no adequately powered prospective study on this cut-off of 6 h to confirm or disprove the dogma. The aim of this study was to provide evidence against the dogma that wounds should be sutured within 6 h after trauma. Method 425 patients were included in a prospective cohort study. Patients' wounds were closed, independent of time after trauma. All patients were seen after 7–10 days for removal of stitches and wound control on infection. Results Of the 425 patients, 17 were lost to follow-up. Of the remaining 408 patients, 45 had wounds older than 6 h after trauma. At follow-up 372 patients (91{\%}) had no infection and 36 patients had redness of the suture sites or worse. 11 patients (2.7{\%}) had general redness or pus. Of those with a wound older than 6 h, three of 45 (6.7{\%}) wounds were infected, versus 30 of 363 (9.1{\%}) in wounds younger than 6 h (p=0.59). Conclusion In everyday practice wounds are sutured regardless of elapsed time. Here an attempt was made to present the evidence for this daily routine, contrary to Friedrich's Dogma.",
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author = "{van den Baar}, M.T.M. and {van der Palen}, {Jacobus Adrianus Maria} and M.I. Vroon and P. Bertelink and Ron Hendrix",
year = "2010",
doi = "10.1136/emj.2009.075846",
language = "English",
volume = "27",
pages = "540--543",
journal = "Emergency medicine journal",
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}

Is time to closure a factor in the occurrence of infection in traumatic wounds? A prospective cohort study in a Dutch level 1 trauma centre. / van den Baar, M.T.M.; van der Palen, Jacobus Adrianus Maria; Vroon, M.I.; Bertelink, P.; Hendrix, Ron.

In: Emergency medicine journal, Vol. 27, 2010, p. 540-543.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Is time to closure a factor in the occurrence of infection in traumatic wounds? A prospective cohort study in a Dutch level 1 trauma centre

AU - van den Baar, M.T.M.

AU - van der Palen, Jacobus Adrianus Maria

AU - Vroon, M.I.

AU - Bertelink, P.

AU - Hendrix, Ron

PY - 2010

Y1 - 2010

N2 - Background The dogma that traumatic wounds should not be sutured after 6 h is based on an animal experiment by P L Friedrich in 1898. There is no adequately powered prospective study on this cut-off of 6 h to confirm or disprove the dogma. The aim of this study was to provide evidence against the dogma that wounds should be sutured within 6 h after trauma. Method 425 patients were included in a prospective cohort study. Patients' wounds were closed, independent of time after trauma. All patients were seen after 7–10 days for removal of stitches and wound control on infection. Results Of the 425 patients, 17 were lost to follow-up. Of the remaining 408 patients, 45 had wounds older than 6 h after trauma. At follow-up 372 patients (91%) had no infection and 36 patients had redness of the suture sites or worse. 11 patients (2.7%) had general redness or pus. Of those with a wound older than 6 h, three of 45 (6.7%) wounds were infected, versus 30 of 363 (9.1%) in wounds younger than 6 h (p=0.59). Conclusion In everyday practice wounds are sutured regardless of elapsed time. Here an attempt was made to present the evidence for this daily routine, contrary to Friedrich's Dogma.

AB - Background The dogma that traumatic wounds should not be sutured after 6 h is based on an animal experiment by P L Friedrich in 1898. There is no adequately powered prospective study on this cut-off of 6 h to confirm or disprove the dogma. The aim of this study was to provide evidence against the dogma that wounds should be sutured within 6 h after trauma. Method 425 patients were included in a prospective cohort study. Patients' wounds were closed, independent of time after trauma. All patients were seen after 7–10 days for removal of stitches and wound control on infection. Results Of the 425 patients, 17 were lost to follow-up. Of the remaining 408 patients, 45 had wounds older than 6 h after trauma. At follow-up 372 patients (91%) had no infection and 36 patients had redness of the suture sites or worse. 11 patients (2.7%) had general redness or pus. Of those with a wound older than 6 h, three of 45 (6.7%) wounds were infected, versus 30 of 363 (9.1%) in wounds younger than 6 h (p=0.59). Conclusion In everyday practice wounds are sutured regardless of elapsed time. Here an attempt was made to present the evidence for this daily routine, contrary to Friedrich's Dogma.

KW - METIS-272827

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DO - 10.1136/emj.2009.075846

M3 - Article

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EP - 543

JO - Emergency medicine journal

JF - Emergency medicine journal

SN - 1472-0205

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