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Suture removal by emergency department patients

  • Author Footnotes
    1 15 Michigan St NE, 736-B, Grand Rapids, MI 49503, United States of America
    Lindsey Ouellette
    Footnotes
    1 15 Michigan St NE, 736-B, Grand Rapids, MI 49503, United States of America
    Affiliations
    Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
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  • Author Footnotes
    2 Nadia Nikroo, Samir Yassin, Kyle Beasley, Noelle Kraus, Justin Houseman, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States of America
    Allison Brown
    Footnotes
    2 Nadia Nikroo, Samir Yassin, Kyle Beasley, Noelle Kraus, Justin Houseman, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States of America
    Affiliations
    Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
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  • Nadia Nikroo
    Affiliations
    Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
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  • Samir Yassin
    Affiliations
    Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
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  • Kyle Beasley
    Affiliations
    Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America
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  • Noelle Kraus
    Affiliations
    Spectrum Health Hospitals, Grand Rapids, MI, United States of America
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  • Justin Houseman
    Affiliations
    Spectrum Health Hospitals, Grand Rapids, MI, United States of America
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  • Jeffrey Jones
    Correspondence
    Corresponding author at: 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States of America.
    Affiliations
    Michigan State University College of Human Medicine, Department of Emergency Medicine, Grand Rapids, MI, United States of America

    Spectrum Health Hospitals, Grand Rapids, MI, United States of America
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  • Author Footnotes
    1 15 Michigan St NE, 736-B, Grand Rapids, MI 49503, United States of America
    2 Nadia Nikroo, Samir Yassin, Kyle Beasley, Noelle Kraus, Justin Houseman, 15 Michigan St NE Suite 701, Grand Rapids, MI 49503, United States of America
      According to the 2016 National Hospital Ambulatory Medical Care (NHAMC) Survey, there were an estimated 145 million visits to emergency departments (ED) during 2016 [
      • Rui P.
      • Kang K.
      • Ashman J.J.
      National Hospital Ambulatory Medical Care Survey: 2016 emergency department summary tables.
      ]. Anywhere from approximately 7 to 9 million lacerations are treated each year in EDs [
      • Otterness K.
      • J. Singer A.
      Updates in emergency department laceration management.
      ]. For each injury that requires sutures, there are a wide variety of wound closure materials, and which material is used depends on many factors. These factors may include the location of the wound, amount of tension on wound edges, provider preference, and patient factors [
      • Otterness K.
      • J. Singer A.
      Updates in emergency department laceration management.
      ]. Previous studies have shown wound evaluation outcome for absorbable versus nonabsorbable sutures are relatively clinically equivalent [
      • Tejani C.
      • Sivitz A.B.
      • Rosen M.D.
      • et al.
      A comparison of cosmetic outcomes of lacerations on the extremities and trunk using absorbable versus nonabsorbable sutures.
      ]. However, if a patient is treated with nonabsorbable sutures, they are instructed to return to a medical care provider to have those sutures removed in a timely fashion. For patients who are uninsured, unable to access an urgent care facility or lacking a primary care provider, the medical care to remove sutures often occurs in the same ED where the laceration repair originally occurred. These visits are costly and could possibly be avoided, saving the health care system valuable medical care dollars. Providing patients with the necessary equipment and instruction may empower and enable patients to remove their non-absorbable sutures at home, thereby avoiding a potentially costly trip to a medical professional. There is very little in the literature that assesses the willingness to, or rate at which patients remove their own sutures. The available literature conveys that although some initial anxiety may be present, patients are willing and able to remove their own sutures after simple procedures and suturing [
      • Albert M.
      • Daly A.
      • Krueger J.
      • et al.
      Self-removal of sutures by emergency department patients.
      ,
      • Macdonald P.
      • Primiani N.
      • Lund A.
      Are patients willing to remove, and capable of removing, their own nonabsorbable sutures?.
      ,
      • Doto T.A.
      • Killick S.R.
      The use of self-removal prolene suture after daycase laparoscopic surgery.
      ]. Therefore, this study sought to: 1) estimate the prevalence of suture removal by patients at home; and 2) determine if ED patients with uncomplicated lacerations were willing to remove their own sutures.

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      References

        • Rui P.
        • Kang K.
        • Ashman J.J.
        National Hospital Ambulatory Medical Care Survey: 2016 emergency department summary tables.
        • Otterness K.
        • J. Singer A.
        Updates in emergency department laceration management.
        Clin Exp Emerg Med. 2019; 6: 97-105
        • Tejani C.
        • Sivitz A.B.
        • Rosen M.D.
        • et al.
        A comparison of cosmetic outcomes of lacerations on the extremities and trunk using absorbable versus nonabsorbable sutures.
        Acad Emerg Med. 2014; 21: 637-643
        • Albert M.
        • Daly A.
        • Krueger J.
        • et al.
        Self-removal of sutures by emergency department patients.
        Ann Emerg Med. 2009; 54: S133
        • Macdonald P.
        • Primiani N.
        • Lund A.
        Are patients willing to remove, and capable of removing, their own nonabsorbable sutures?.
        Can J Emerg Med. 2012; 14: 218-223
        • Doto T.A.
        • Killick S.R.
        The use of self-removal prolene suture after daycase laparoscopic surgery.
        Surg Laparosc Endosc Percutan Tech. 2006; 16: 334-337