A randomized controlled trial for the cost-effectiveness of using tissue adhesive (Dermabond) & suture

Abstract

Background Simple wound closure is normally performed with suture by trained emergency nurse in Hong Kong. The aim of the study was to compare two wound closure methods: octylcyanoacrylate tissue adhesive (Dermabond ) as tissue adhesives and suture in term of cost-effectiveness, outcome appearance, pain and satisfaction for patients who received wound closure in emergency department in Hong Kong . Method: A randomized, unblinded, controlled trial design was used. Patients who met the inclusion criteria (age ≥ 18, ambulatory, with simple laceration wound) were invited for the study. Patients were randomly assigned to either the control (wound closure by suture-standarrd nylon stitches) or experimental group( wound closure by tissue adhesive (Dermabond). Wound follow up was performed at day 14, 30 and 90. Wound outcomes were determined by cost –effectiveness analysis , Wound Evaluation Score (WES), Visual Analog Comesis Scale (VACS ), Visual Analog scale (VAS) for pain level and satisfaction level.

Results:185 patients completed the study with 90 on control group and 95 on experimental group. There were homogenous in demographic variables (age, sex, mechanism of injury, wound length, wound life) between 2 groups. At D14 review, there was no significant different in term of wound evaluation score (WES) between 2 groups as reviewed by assigned wound assessors (P =0.27). However, patients of experimental group have statically higher satisfaction level (91.3 VS 85.2 P<0.005) & better cosmetic appearance score (VACS) P<0.005 at 3 time points. No significant difference in pain level between groups at day 14, 30 and 90 (F(1,183)=2.67 P= .11 ). The total cost per Dermbond case was much cheaper than the cost of suture due to the saving in nursing time and wound follow up.

Conclusion:Wound closure with tissue adhesive (Dermabond) is a comparable cheaper, better appearance outcome wound closure material for acute wound management.