Incidence and Characterization of Facial Lacerations in Emergency Departments in the United States

Study design: This is a retrospective study using the Nationwide Emergency Department Sample.

Objective: Facial laceration repairs are one of the most common procedures performed in the emergency department (ED). The goal of this study was to describe the patient's characteristics and healthcare cost associated with ED encounters for facial lacerations using the largest nationally representative database in the United States.

Methods: This is a retrospective study using the Nationwide Emergency Department Sample. The data was collected between January and December of 2019. Patients with either a primary or secondary diagnosis of facial laceration were included. The primary outcome was patient characteristics. The secondary outcomes were ED characteristics, number and type of procedures performed and total encounter charges. Diagnoses and procedures were identified using ICD-10 CM codes.

Results: There were 2,548,944 ED encounters for facial lacerations in the United States. Of those, laceration was the chief complaint in 75%. 80% of lacerations were unintentional, 8% were due to assaults, and <1% due to suicidal attempts. The most common laceration location was the scalp (21%) followed by the lip (11%) and eyelid (11%). The mean patient age was 38 years. Most patients were adults (69%), male (62%), Caucasian (64%, African American 14%, Hispanic 14%, Other 4%, Asian 2%), from low income levels ($1-$45,999: 29%, $46,000- $58,999: 24%, $59,000-$78,999: 24%, $79,000 or more: 23%), with private insurance (32%, Medicaid 25%, Medicare 24%, self-pay 12%, other 6%). Most encounters were during summer (June, July, August) at large metropolitan areas with at least 1 million residents (52%, small metropolitan: 30%, micropolitan: 10%, other: 7%) at teaching hospitals (65%) located in the southern region of the United States (37%, Midwest: 23%, west: 21%, northeast: 19%). Almost half of the encounters were at non-trauma-designated hospitals (48%, Level 1 trauma center: 21%, Level 2 trauma center: 17%, Level 3 trauma center: 13%). The number of procedures during each encounter was: none: 4%, one: 17%, two: 23%, three: 11%, four: 11%, five or more: 28%. The most frequent laceration repair was a simple repair of superficial wounds of the face, ears, eyelids, nose, lips, and/or mucous membranes 2.5 cm or less, followed by simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities 2.5 cm or less. Most emergency department visits were billed as a Level 3 encounter, followed by Level 2 then Level 4. CT scan of the head was the most common imaging modality. Of all patients, <1% were admitted to the hospital and 87% were discharged home. The average total emergency department charges were $5,733.

Conclusions: Facial laceration is a common complaint in the emergency department. It is costly, and disproportionately affects the impoverished. Most lacerations are classified as simple, less than 2.5 cm, involving the scalp, unintentional, with the discharge disposition being home. Thus, exploring pathways to treat facial lacerations outside of the ED can potentially reduce both healthcare cost and ED crowding.