Valente JH, Forti RJ, Freundlich LF, et al. Wound irrigation in children: Saline solution or tap water? Ann Emerg Med 2003; 41:609-616.

There is no apparent difference in infection rates between wounds irrigated with tap water or normal saline solution, says this study from Jacobi Medical Center and Albert Einstein College of Medicine in Bronx, NY. The researchers evaluated pediatric patients ages 1 to 17 with simple lacerations. Wounds were irrigated with running tap water or normal saline solution, and the patients returned to the ED 48-72 hours later for evaluation. Wound infection rates were similar: 2.8% infection rate for the normal saline solution group and 2.9% in the tap-water group.

Although standard of care in the ED is to use sterile normal saline solution with a syringe for pressure irrigation of wounds, this study’s findings suggest that tap water is an equally effective alternative, say the researchers. "Tap water is cheap, clean, and abundant, and might be a suitable irrigating fluid for cleaning simple wounds," they wrote. They point to the following advantages of tap water use:

  • Decreased cost of wound care in the ED. The researchers say that in their ED, the cost of a 60 mL syringe, splash guard, and liter bottle of normal saline solution is $2.01. If all of the 530 patients enrolled had received tap water irrigation, approximately $1,065 would have been saved, they say.
  • Possible lessened biohazard risk, because irrigation time is less to provide the same amount of water and the distance from the irrigation source is increased.
  • Less anxiety by children, since tap water from a faucet or hose is less threatening than irrigation from a syringe.

Magaret ND, Clark TA, Warden CR. Patient satisfaction in the emergency department — A survey of pediatric patients and their parents. Acad Emerg Med 2002; 9:1,379-1,388.

The management of pain in pediatric patients was a key factor for satisfaction of pediatric ED patients, says this study from the Oregon Health & Science University in Portland.

Researchers surveyed 101 pairs of children and their parents or guardians who were treated at a pediatric ED. The researchers found that satisfaction of parents was linked to the quality of provider-patient interactions, the adequacy of information provided, and shorter waiting room ties. Satisfaction of children was linked to the quality of provider-patient interactions, the adequacy of information provided, and pain resolution.

The researchers note that satisfaction of pediatric patients has not been assessed directly. They also noted that 75% of the patients received no analgesia, yet they reported some pain.

"These results reinforce the importance of sequential pain assessment, treatment, and reassessment in children," they wrote. "It also reinforces the need for health care personnel to ask parents specifically about concerns that they have related to their children’s pain and to provide reassurance that pain can and will be adequately treated."

Scheetz LJ. Effectiveness of prehospital trauma triage guidelines for the identification of major trauma in elderly motor vehicle crash victims. J Emerg Nurs 2003; 29:109-115.

Older trauma victims are at risk of being undertriaged, according to this study from the State University of New Jersey College of Nursing in Newark. The researcher retrospectively studied patient discharge data for 2,063 adults involved in motor vehicle crashes in 2000, to assess whether patients were overtriaged or undertriaged, and compared young and middle-aged adults with older adults. The study found that while overtriage was present in all age groups, 8% of young and middle-aged men, 12% of young and middle-aged women, 18% in older men, and 15% of older women were undertriaged. The researcher suggests that older trauma victims are more likely to have a decrease in physiologic reserve and to take potent medications for chronic diseases, which could produce a blunted physiologic response to major trauma. As a result, the researcher recommends that guidelines should include age as a factor, to avoid undertriage of older patients.

"Every emergency nurse, especially those working in nontrauma emergency departments, should be alert to the possibility of major trauma in patients, especially older patients, who might have been undertriaged in the field," she wrote. She recommends that ED nurses do the following:

  • careful assessment with serial measurements of heart rate, blood pressure, respiratory status, and neurologic status;
  • manual measurement of blood pressure, or manually verifying readings from electronic blood pressure monitors periodically;
  • measurement of the patient’s Glasgow Coma Score periodically, until head trauma has been ruled out.