Racial Equity in Facial Laceration Repair: Evaluating a Pediatric Plastic Surgery Consult Guideline

Authors

• David Mills, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA. Electronic address: [email protected].
• Isabella G. Steidley, Brown University, Providence, RI.
• Elizabeth M. Waltman, UMass Chan Medical School, Worcester, MA.
• Amir A. Kimia, Connecticut Children's Medical Center, Hartford, CT.
• Michael C. Monuteaux, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA.
• Todd W. Lyons, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA.
• Andrew F. Miller, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA.
• Chris A. Rees, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA.
• Assaf Landschaft, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA.
• Amanda M. Stewart, Children's National Hospital, Washington, DC; The George Washington University School of Medicine and Health Sciences, Washington, DC.
• Ingrid Ganske, Harvard Medical School, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
• Eric W. Fleegler, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.

Document Type

Journal Article

Publication Date

4-9-2026

Journal

American journal of preventive medicine

DOI

10.1016/j.amepre.2026.108364

Keywords

Disparities; Emergency Medicine; Health Equity; Pediatric Laceration; Plastic Surgery

Abstract

INTRODUCTION: Facial lacerations are of particular concern to families due to the potential for long-term cosmetic outcomes. Plastic surgery consultation may be requested for facial laceration repair at specialized centers, yet multiple factors may drive inequitable access to care. The objective of this study was to evaluate whether racial and ethnic inequities existed in plastic surgery consultation rates for facial laceration repair. METHODS: Retrospective cross-sectional study of facial laceration repairs between 2016 and 2022 at a single center, urban quaternary care freestanding children's hospital. All patients aged 0 to 18 years who received a facial laceration repair in the pediatric emergency department were included. A clinical practice guideline (CPG) for plastic surgery consultation was implemented in March 2020. RESULTS: 6,938 unique laceration encounters were included in the study. Unadjusted plastic surgery repair rates in the pre-guideline period were: Hispanic 8.5% (n=71/832), non-Hispanic Black 6.7% (n=31/462) and non-Hispanic White 28.5% (639/2,241) and following guideline implementation: Hispanic 5.9% (n=17/286), non-Hispanic Black 7.3% (n=9/124) and non-Hispanic White 11.9% (103/867). Prior to the CPG implementation, non-Hispanic Black patients had significantly lower odds of plastics repair compared to non-Hispanic White patients (aOR 0.18 [95% CI 0.11, 0.29]). Following CPG implementation, no statistically significant difference was detected (aOR 0.63 [95% CI 0.30, 1.31]). CONCLUSION: Previously unrecognized health inequities in plastic surgery consultation rates existed prior to and resolved after implementation of a consultation guideline for facial laceration repair. The study provides insight into the potential secondary benefits of guideline implementation to reduce health inequities.

APA Citation

Mills, David; Steidley, Isabella G.; Waltman, Elizabeth M.; Kimia, Amir A.; Monuteaux, Michael C.; Lyons, Todd W.; Miller, Andrew F.; Rees, Chris A.; Landschaft, Assaf; Stewart, Amanda M.; Ganske, Ingrid; and Fleegler, Eric W., "Racial Equity in Facial Laceration Repair: Evaluating a Pediatric Plastic Surgery Consult Guideline" (2026). GW Authored Works. Paper 9085.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/9085

Department

Pediatrics