The parent of a 2-year-old child who fell and sustained a scalp laceration that will require suturing asks the nurse, "How serious an injury is this?" The nurse responds by stating:
1. "From the description of the fall it doesn't appear serious, but the x-ray will tell us for sure.".
2. "There is a lot of bleeding, but it is really a rather superficial injury.".
3. "Children this age are really resilient, but you never know until the x-rays are read.".
4. "He'll need a few stitches and a tetanus injection, but that should do it.".
"From the description of the fall it doesn't appear serious, but the x-ray will tell us for sure.".
Rationale: Scalp lacerations account for a large number of emergency department visits and are usually not serious, but with any scalp laceration, the possibility of an underlying skull fracture must be addressed. An accurate history of the event surrounding the injury is very important. If there is any reason to suspect a skull fracture, a computerized tomography (CT) scan or a plain x-ray of the skull should be obtained. Telling the parents that the wound is superficial without the benefit of radiological confirmation is inappropriate. Stating that children are resilient is minimizing the parent's concern, and stating that a few stitches and a tetanus injection is all that is needed is minimizing the potential of the injury.
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