Staples may be more effective and quicker than sutures in children with scalp lacerations
Date First Published:
October 24, 2001
Last Updated:
November 13, 2002
Report by:
Kerstin Hogg, Clinical Research Fellow (Manchester Royal Infirmary)
Search checked by:
Simon Carley, Manchester Royal Infirmary
Three-Part Question:
Are [staples better than sutures] in [children with scalp lacerations] for [ease of application and patient comfort]?
Clinical Scenario:
An eight year old boy is brought to the emergency department by his parents, after tripping and hitting his head on the table edge. He has a 2cm laceration over the occipital region. You examine the wound and wonder whether staples might be an easier alternative to sutures.
Search Strategy:
Medline 1966-04/02 using the OVID interface and Cochrane Library, Issue 1 2002.
Search Details:
Medline:[(exp Sutures OR sutur$.mp OR exp Suture Techniques OR stitch$.mp) AND (exp Surgical Staplers OR exp Surgical Stapling OR stapl$.mp) AND (exp Scalp OR scalp.mp OR exp Craniocerebral Trauma OR head.mp OR head injur$.mp) AND (exp child OR exp adolescence OR exp child, abandoned OR exp child, exceptional OR exp child, hospitalized OR exp child, institutionalized OR exp child of impaired parents OR exp child, preschool OR exp child, unwanted OR exp disabled children OR exp homeless youth OR exp infant OR exp only child OR child$.mp OR exp pediatrics OR pediatric$.mp OR paediatric$.mp)] Cochrane: SURGICAL-STAPLERS*:ME AND SUTURES*:ME AND CHILD*:ME
Outcome:
Medline: 8 papers were found of which 7 were irrelevant. The remaining paper was also found in Cochrane (3 papers found, 2 irrelevant).
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations : A randomised study of cost and time benefits. Kanegaye JT, Vance CW, Chan L, et al. 1997, USA | 88 patients age 13 months to 16 years, attending emergency department with scalp lacerations | Prospective randomised study | Parental satisfaction | No difference between groups | No fixed protocol for local anaesthetic administration Costs assume repair by a physician Group size too small to effectively establish rate of wound complications |
| Patient restraint | Some form of immobilisation used in 49% staple group and 60% suture group. | ||||
| Speed of repair | Staples were 6 times faster than sutures per wound, and 8 times faster per cm wound repaired. Taking into account skin preparation time, stapling was twice as fast. Fellows were one and a half times faster at stapling than residents. | ||||
| Wound complications at 7 days | One glove punctured during staple repair, and two needles lost during suturing. | ||||
| Needle stick injuries | Staples cost 39% less than sutures per wound closure, even when paying a fellow rather than a resident. | ||||
| Cost of repair | No statistical difference between scores. | ||||
| Patient pain (self reported) |
Author Commentary:
The evidence appears encouraging that staples are a cheaper, faster and effective way of closing scalp wounds in children, but larger studies are required to confirm this.
Bottom Line:
Staples may turn out to be more effective at scalp wound closure in children, but further research is awaited.
Level of Evidence:
Level 3: Small numbers of small studies or great heterogeneity or very different population
References:
- Kanegaye JT, Vance CW, Chan L, et al.. Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations : A randomised study of cost and time benefits.