Long-term evaluation of cosmetic appearance of repaired lacerations: Validation of telephone assessment

Objective: Patients with lacerations are most concerned about the ultimate cosmetic appearance of their wound. We evaluated methods to assess the long-term cosmetic appearance by telephone survey. Methods: Patients with lacerations repaired in the ED were contacted by telephone and had direct examination a mean of 112 days after injury. At the time of telephone contact to schedule the ED follow-up visit, patients completed a structured survey instrument. Patients rated their laceration appearance from 0 to 100, and completed a 6-item categorical assessment of cosmetic appearance. During ED follow-up, patients assessed satisfaction with a 100-mm visual analog scale (VAS), a 0 to 100 numerical scale, and the same 6-item categorical scale. The criterion standard was the validated 6-item categorical scale used by physicians. A score of 6 is optimal; less than 6 is suboptimal. Results: A total of 103 patients participated (mean age 17 years; 55% male subjects). Wounds were mostly located on the head (72%) and upper extremity(24%). Mean wound length was 1.9 cm. On all numerical scales (numerical assessment by telephone, assessment in the ED by VAS, and by 0 to 100 scale in the ED) the patients considered the wound better when the physicians considered the cosmetic appearance to be optimal (87 mm versus 71 mm; 90 mm versus 73 mm; 90 mm versus 73 mm, respectively; P<.01 for all comparisons). The relationship between the 0 to 100 numerical rating scale used in the ED and that used during the telephone survey revealed a strong relationship. The scales had a mean difference of 2.1 mm (95% confidence interval -26 to 30 mm). However, patient categorical scale assessment from the phone interview was not concordant with physician assessment in the ED (kappa=.12). Conclusion: The long-term cosmetic appearance of lacerations repaired in the ED can be assessed by asking patients to grade their lacerations from 0 to 100 over the telephone. By contrast, categorical assessment over the telephone is not concordant with physician assessment in the ED. This information may allow easier assessment of injuries and their long-term consequences.