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​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite.
Cochrane Database Syst Rev 2019; 12:CD011822CD

Abstract

BACKGROUND

Mammalian bites are a common presentation in emergency and primary healthcare facilities across the world. The World Health Organization recommends postponing the suturing of a bite wound but this has not been evaluated through a systematic review.

OBJECTIVES

To assess the effects of primary closure compared with delayed closure or no closure for mammalian bite wounds.

SEARCH METHODS

In July 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.

SELECTION CRITERIA

We included randomised controlled trials which compared primary closure with delayed or no closure for traumatic wounds due to mammalian bite.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts and full-text publications, applied the inclusion criteria, and extracted data. We pooled data using a random-effects model, as appropriate. We used the Cochrane 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We found three trials (878 participants) that compared primary closure with no closure for dog bites and one trial (120 participants) that compared primary closure with delayed closure. No other mammalian bite studies were identified. The trials were from the UK (one trial), Greece (one trial) and China (two trials). Overall, participants from both sexes and all age groups were represented. We are uncertain whether primary closure improves the proportion of wounds which are infection-free compared with no closure, as the certainty of evidence for this outcome was judged to be very low (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.97 to 1.05; 2 studies, 782 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. There is no clinically important difference in cosmesis (acceptable physical/cosmetic appearance) of dog bite wounds when primary closure is compared with no closure (mean difference (MD) -1.31, 95% CI -2.03 to -0.59; 1 study, 182 participants). The certainty of evidence for this outcome was judged to be moderate (we downgraded our assessment by one level for imprecision). We are uncertain whether primary closure improves the proportion of dog bite wounds that are infection-free compared with delayed closure, as the evidence for this outcome was judged to be very low (RR 0.98, 95% CI 0.90 to 1.07; 1 study, 120 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. None of the four trials reported any adverse outcomes such as death or rabies but they were, in any case, unlikely to have been large enough to have satisfactory power to provide precise estimates for these. Important outcomes like time to complete wound healing, proportion of wounds healed, and length of hospital stay were not evaluated.

AUTHORS' CONCLUSIONS

All the studies we identified concerned dog bites. There is no high-certainty evidence to support or refute existing recommendations concerning primary closure for dog bites. The potential benefits and harms of primary closure compared with delayed or no closure for mammalian bites remain uncertain and more robust trials are needed.

Authors+Show Affiliations

The George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, India, 110025.Christian Medical College, Cochrane South Asia, Prof. BV Moses Centre for Evidence-Informed Healthcare and Health Policy, Carman Block II Floor, CMC Campus, Bagayam, Vellore, India, 632002.Christian Medical College, Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Ida Scudder Road, Vellore, Tamil Nadu, India, PIN 632004.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31805611

Citation

Bhaumik, Soumyadeep, et al. "​Primary Closure Versus Delayed or No Closure for Traumatic Wounds Due to Mammalian Bite." The Cochrane Database of Systematic Reviews, vol. 12, 2019, p. CD011822.
Bhaumik S, Kirubakaran R, Chaudhuri S. ​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite. Cochrane Database Syst Rev. 2019;12:CD011822.
Bhaumik, S., Kirubakaran, R., & Chaudhuri, S. (2019). ​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite. The Cochrane Database of Systematic Reviews, 12, p. CD011822. doi:10.1002/14651858.CD011822.pub2.
Bhaumik S, Kirubakaran R, Chaudhuri S. ​Primary Closure Versus Delayed or No Closure for Traumatic Wounds Due to Mammalian Bite. Cochrane Database Syst Rev. 2019 Dec 6;12:CD011822. PubMed PMID: 31805611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite. AU - Bhaumik,Soumyadeep, AU - Kirubakaran,Richard, AU - Chaudhuri,Sirshendu, Y1 - 2019/12/06/ PY - 2020/12/06/pmc-release PY - 2019/12/6/entrez PY - 2019/12/6/pubmed PY - 2019/12/6/medline SP - CD011822 EP - CD011822 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev VL - 12 N2 - BACKGROUND: Mammalian bites are a common presentation in emergency and primary healthcare facilities across the world. The World Health Organization recommends postponing the suturing of a bite wound but this has not been evaluated through a systematic review. OBJECTIVES: To assess the effects of primary closure compared with delayed closure or no closure for mammalian bite wounds. SEARCH METHODS: In July 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials which compared primary closure with delayed or no closure for traumatic wounds due to mammalian bite. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles, abstracts and full-text publications, applied the inclusion criteria, and extracted data. We pooled data using a random-effects model, as appropriate. We used the Cochrane 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We found three trials (878 participants) that compared primary closure with no closure for dog bites and one trial (120 participants) that compared primary closure with delayed closure. No other mammalian bite studies were identified. The trials were from the UK (one trial), Greece (one trial) and China (two trials). Overall, participants from both sexes and all age groups were represented. We are uncertain whether primary closure improves the proportion of wounds which are infection-free compared with no closure, as the certainty of evidence for this outcome was judged to be very low (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.97 to 1.05; 2 studies, 782 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. There is no clinically important difference in cosmesis (acceptable physical/cosmetic appearance) of dog bite wounds when primary closure is compared with no closure (mean difference (MD) -1.31, 95% CI -2.03 to -0.59; 1 study, 182 participants). The certainty of evidence for this outcome was judged to be moderate (we downgraded our assessment by one level for imprecision). We are uncertain whether primary closure improves the proportion of dog bite wounds that are infection-free compared with delayed closure, as the evidence for this outcome was judged to be very low (RR 0.98, 95% CI 0.90 to 1.07; 1 study, 120 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. None of the four trials reported any adverse outcomes such as death or rabies but they were, in any case, unlikely to have been large enough to have satisfactory power to provide precise estimates for these. Important outcomes like time to complete wound healing, proportion of wounds healed, and length of hospital stay were not evaluated. AUTHORS' CONCLUSIONS: All the studies we identified concerned dog bites. There is no high-certainty evidence to support or refute existing recommendations concerning primary closure for dog bites. The potential benefits and harms of primary closure compared with delayed or no closure for mammalian bites remain uncertain and more robust trials are needed. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/31805611/​Primary_closure_versus_delayed_or_no_closure_for_traumatic_wounds_due_to_mammalian_bite L2 - https://doi.org/10.1002/14651858.CD011822.pub2 DB - PRIME DP - Unbound Medicine ER -