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Tracking the prehospital time course of open fracture patients
James D Brodell1, Andrew J Rodenhouse1, Hashim J F Shaikh1
1Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, Rochester, NY, USA.
Insights
Many open fracture patients experience delays in prehospital care, exceeding one hour. Early antibiotic administration before hospital arrival could significantly reduce the risk of fracture-related infections (FRI).
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Infectious Disease
Background:
- Timely antibiotic administration is crucial for managing open fractures and preventing infection.
- Current guidelines focus on in-hospital antibiotic timing, often within one hour of arrival.
- The impact of prehospital delays on fracture-related infection (FRI) risk is not well understood.
Purpose of the Study:
- To investigate the prehospital time course for open fracture patients.
- To determine the proportion of patients experiencing delays greater than one hour from injury to hospital care.
- To explore the association between prehospital time and the development of FRI.
Main Methods:
- Retrospective case series of 454 adult open fracture patients treated at an academic Level I trauma center.
- Data included prehospital (dispatch, on-scene, transport) and in-hospital times, fracture details, and FRI development.
- Descriptive statistics were used to analyze time intervals and correlations.
Main Results:
- Over half (52.6%) of patients had a transfer of care time exceeding one hour from dispatch.
- Mean prehospital time was 66.8 minutes, with helicopter transport showing longer delays (84.1 minutes).
- Only 3.7% of patients received prehospital antibiotics, and prolonged prehospital time correlated positively with FRI development.
Conclusions:
- A significant number of open fracture patients experience prolonged prehospital delays.
- Increased prehospital time is associated with a higher risk of developing fracture-related infections.
- Prehospital antibiotic administration presents a potential strategy to mitigate infection risk in open fracture patients.
Objectives:
A tenet of open fracture management is timely administration of antibiotics to reduce risk of fracture-related infection (FRI). Trauma centers strive to administer intravenous antibiotics within one hour of patient arrival. The foundation for this recommendation is based on relatively few studies, which base their findings on time from hospital arrival to antibiotic administration. Little attention has been paid to the prehospital time course of open fracture patients. We hypothesized that a significant portion of open fracture patients arrive at the hospital greater than one hour after their injury, which would represent an opportunity for improved care.
Methods:
Design: Retrospective Case Series Setting: Urban/Suburban Academic Level I Trauma Center Patient Selection Criteria: Subjects were identified using a retrospective search for open fracture patients arriving via emergency medical services (EMS). Patients were included if they were age 18 or greater, presented with an open fracture, and had complete pre-hospital documentation, in-hospital documentation, and radiographs. Outcome Measures and Comparisons: Data collected included patient demographics, fracture location, Gustilo-Anderson classification, dispatch time, on scene time, enroute to hospital time, arrival at hospital time, transfer of care time, modality of transport, whether intravenous antibiotics were administered prior to arrival at the hospital, and development of FRI. Descriptive statistics were used to analyze the findings.
Results:
454 patients met the inclusion criteria. Mean time from dispatch to transfer of care was 66.8 ± 26.9 min in all transports; 84.1 ± 25.6 min with helicopter EMS; and 64.8 ± 26.4 min with ground EMS. 239 patients (52.6 %) had transfer of care time greater than one hour after dispatch time. Only 3.7 % of open fracture patients received antibiotics prior to hospital arrival. There was a positive correlation with the development of FRI and prolonged pre-hospital time.
Conclusions:
Many patients with open fractures had transfer of care more than one hour after dispatch. FRI was associated with increased prehospital time. These results suggest an opportunity for prehospital antibiotic administration to mitigate the risk of infection in patients with open fractures.
Level Of Evidence:
Level IV.
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