Comparison of patient satisfaction and practitioner satisfaction with wound appearance after traumatic wound repair.
BACKGROUND
Existing cosmetic scales for wounds are based only on practitioners' evaluations. They have not been validated using the patient's assessment.


OBJECTIVE
To validate a previously developed wound cosmesis scale by determining the relationship between patient and practitioner assessments of cosmetic outcome following traumatic wound repair.


METHODS
A convenience sample of patients with lacerations repaired in an ED were evaluated at the time of suture removal. Practitioners assigned 0 or 1 point each for the presence or absence of a step-off of borders; contour irregularities; margin separation; edge inversion; excessive distortion; and overall appearance. A total cosmetic score was calculated by adding the categories above. As previously defined, a score of 6 was considered optimal; < 6 was considered "suboptimal." Patients, blinded to the physician score, assessed their degrees of satisfaction with the cosmetic outcome of the wounds using a 100-mm visual analog scale (VAS). Because VAS scores were not normally distributed, practitioner scores were compared with patient satisfaction scores using a Mann-Whitney U test.


RESULTS
125 patients were enrolled, of whom 64% were male; the median age was 19.5 years (interquartile range = 8-33 years). Wounds were located predominantly on the face, scalp, or neck (47%) and upper extremity (35%), and had a median length of 2 cm. The 86 lacerations given optimal practitioner scores had a median patient satisfaction score of 97 mm; the 39 "suboptimal" lacerations had a median patient satisfaction score of 87 mm (p = 0.0006).


CONCLUSIONS
Lacerations that practitioners considered to have optimal cosmetic appearances at the time of suture removal received higher patient satisfaction scores than did lacerations considered to be suboptimal. This provides a measure of validity to this 6-item categorical cosmetic scale.
Singer
A J
AJ
University Medical Center, Department of Emergency Medicine, State University of New York, Stony Brook 11794-7400, USA. asinger@epo.som.sunysb.edu
Church
A L
AL
Forrestal
K
K
Werblud
M
M
Valentine
S M
SM
Hollander
J E
JE
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D009518:New York; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013518:Surgery, Plastic / Q000592:standards; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*