Bumping to a rollator walker: How pretibial hematomas create more costs than pretibial lacerations.

Pretibial lacerations (PL) and pretibial hematomas (PH) are debilitating traumas among the elderly and infirm. The injuries are frequently grouped together despite differences in treatment and symptoms. Patients are known to have multiple contacts in health care, perhaps because of inadequate treatment. Despite the burden, financial costs have not been assessed. Calculate and compare the treatment costs of PLs and PHs for differences and provide economic incentives to treat and diagnose patients optimally. From linkage to ICD10 diagnoses, we analysed NordDRG product invoices generated by the treatment of the patients. We calculated and compared the costs of treatment in both cohorts from the invoices. This method has not been previously used for analysing wound care costs. Mean treatment costs were 1800€ (PL) and 3300€ (PH). The total costs, emergency room, surgical treatment, and inpatient care of PHs were higher than PLs (P = .0486, P = .0002, P = .0058, P = .6526). PLs generate more costs from the outpatient clinic but were not statistically significant (P = .6533). PHs cause a higher economic burden than PLs. Costs arise from repeat ER visits and the need for surgeries because of delayed treatment. PLs have multiple contacts in the wound clinic. Improvement in the diagnosis and treatment of both injuries is needed.

Prevention and management of skin tears in older people.

Skin tears are frequently encountered in emergency and unscheduled care, and are prevalent in older people. Patients may present soon after an acute skin tear, or at a later stage when the wound presentation is different and there are complications. This article describes evidence-based recommendations and strategies for the prevention, assessment and management of skin tears, discusses risk factors and explains when to refer patients for specialist management.

Pretibial lacerations.

Patients with pretibial lacerations are commonly referred to plastic surgery services for operative intervention. However, the vast majority of cases can be managed conservatively. Through understanding the epidemiology and pathophysiology underlying these injuries to appropriately assessing and managing these patients, this review demonstrates how best to facilitate wound healing and undertake conservative management. A multidisciplinary approach to managing patients with pretibial lacerations is discussed so that clinicians can provide a better quality of life for patients through optimisation and preventing further decline.

The management of pretibial lacerations.

Introduction Pretibial lacerations are common injuries, often presenting in the elderly and infirm. Unclear management pathways often result in inappropriate care. We identify patient demographics, morbidity risk factors, injury severity and management options. Materials and methods This retrospective study involved analysing databases and hardcopy notes for patients admitted with pretibial lacerations to Addenbrooke's Hospital, January to December 2012. Microsoft Excel and Fishers exact test were used to analyse the data with a P-value of less than 0.05 representative of statistical significance. Information on patient demographics, site of lesion, preoperative symptoms, management, operative details and clinical outcomes were collected. Results A total of 36 patients were identified; the mean age was 79 years (± 16 years, 1 standard deviation) with a three to two female to male preponderance; 57% of injuries were caused by mechanical fall, 33% traumatic blunt impact and 7% road traffic accidents. American Society of Anesthesiologists physical status classification was 43% level III, 40% II, 9% I and 9% IV. Dunkin classification of severity was 33% grade III, 30% grade I, 24% grade IV and 12% grade II. Median inpatient duration was 11 days for surgically managed compared with 15 days for conservatively managed patients. Discussion Pretibial lacerations tend to affect the elderly. Management is compounded by polypharmacy and comorbidities. If inadequately managed, such injuries can adopt characteristics of chronic wounds, with lengthy inpatient stays. Surgical intervention may be appropriate where injuries are severe and the patient stable enough for theatre. Conclusions We believe that surgical management with autologous tissue repair, with minimal delay between presentation and theatre, is warranted for extensive injuries wherever possible, with conservative management used for predominantly less extensive pretibial lacerations.

The epidemiology and mortality of pretibial lacerations.

Pretibial lacerations are common injuries which have an underestimated mortality associated with their occurrence, and an under-appreciated morbidity associated with their treatment - they account for 5.2 out of every 1000 Emergency Department attendances in the United Kingdom, and occur mostly in the elderly. They are also increasingly being referred to plastic surgery units - the authors' department saw an increase from 58 referrals in twelve months in 2005/2006 to 113 referrals in six months in 2011. The Queen Victoria Hospital, East Grinstead, follows an evidence based and multi-disciplinary practice for the treatment of these injuries. The authors present the outcomes of patients referred to the hospital from the community and treated according to these guidelines, and compares the outcomes and mortality to a period prior to the introduction of this practise. The average time for skin grafted wounds to heal is found to be 59.8 days and for the donors it is 50.3 days, compared with an average time to healing of 123 days for those managed conservatively. The one month and one year mortality associated with these injuries is highlighted, as is the reduction in these figures following the adherence to the current treatment regime - prior to its introduction the 31 day mortality was 15%, and this was reduced to 4.3% by achievable changes in practice and treatment. Finally, the relevant extant research literature regarding pretibial lacerations is reviewed.