Clinical characteristics and management of wound foreign bodies in the ED

Objectives: Wound foreign body (FB) management is challenging. Little data exist describing ED management. We sought to describe case characteristics and ED management of wound FBs. Methods: Retrospective case series of all patients with ICD-9 code diagnosis of wound FB over 4 years in 2 EDs. Results: Four hundred ninety cases met inclusion criteria. A total of 75.6% presented within 48 hours of injury. Wounds from foreign material or stepping on something accounted for two thirds of the mechanisms. Most were wood, metal, or glass. Diagnosis was primarily by physical exam with exploration (77.6%; 95% confidence interval, 73.4%-81.5%), but 22.4% (95% confidence interval, 18.5-26.6%) were only diagnosed radiographically. X-rays missed 25% of glass and 93% of wood FBs. Eighty-nine percent were removed in the ED. Consultation was uncommon (9.6%). Conclusions: Most, but not all, patients with wound FBs presented within 48 hours of injury and had suspicious complaints or mechanisms. Diagnosis was usually clinical but sometimes only by radiography. Radiographs were not sufficiently sensitive to reliably detect wood and glass. Most FBs were successfully removed without specialty consultation.