Patient outcomes association with patient factors and care provided: trauma registry derived cohort study

To determine the association of delay in treatment with injury-specific patient outcomes.

This was a single-center, longitudinal cohort study on orthopaedic trauma registry. Data on patients enrolled between June 2015 and June 2018 were analyzed. Data was collected from admitted consenting patients' medical records. Definitive surgical care provided after 24 hours was considered as 'delayed surgical treatment'. Outcomes of patients were serially assessed on follow-up visits up to 12 months using injury-specific scoring system.

A total of 789 patients, were enrolled with 856 upper or lower extremity injuries altogether; in 67 cases both extremities were involved. Surgery was done in 90% while 10% were managed conservatively. A delay in the surgical procedure was experienced by 185(23%) patients. Mortality was 3.28% (6 of 185) in the delayed treatment group and 1% (6 of 603 patients) in the early treatment group (p=0.046). In proximal femur there was a nonsignificant trend towards better outcomes in the early treatment group at 3 and 12 months (p=0.06), while in Tibial shaft fractures, there was a non-significant trend towards better outcomes in the delayed treatment group at 3 and 6-months (p=0.09). There was no association between treatment delay for distal radius and proximal humerus fractures and their outcomes.

Our trauma registry model provides outcomes data enabling identification of patient subsets who did not achieve good outcome, and suggests possible role of delay in surgical treatment beyond 24 hours in the outcomes..