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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.
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

Search 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)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Kanegaye JT 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	None
			Needle stick injuries	One glove punctured during staple repair, and two needles lost during suturing.
			Cost of repair	Staples cost 39% less than sutures per wound closure, even when paying a fellow rather than a resident.
			Patient pain (self reported)	No statistical difference between scores.

Comment(s)

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.

Clinical 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

1. 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. J Pediatr 1997;130(5):808-13.