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J Orthop Trauma. 2011 Mar;25(3):140-4. doi: 10.1097/BOT.0b013e3181e3dff1.

Delay in surgical débridement of open tibia fractures: an analysis of national practice trends.

Author information

1
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia PA, USA. Samir.Mehta@uphs.upenn.edu

Abstract

BACKGROUND:

Débridement and irrigation (D&I) of open tibia fractures less than 6 hours from the time of injury has been promoted as orthopaedic dogma despite limited evidence. The goal of this study was to determine the duration between emergency room presentation and D&I in open tibia fractures and to examine factors associated with delay in treatment.

METHODS:

The National Trauma Data Bank Version 3.0 identified 6099 blunt trauma patients with open tibia fractures. Time was calculated from emergency room arrival to first D&I. Risk factors associated with delay in treatment greater than 6 hours and greater than 24 hours were then calculated using univariate and multivariate statistical methods.

RESULTS:

Median time to D&I was 4.9 hours. Forty-two percent of patients with open tibia fractures experienced a delay in treatment of greater than 6 hours and 24% of patients experienced a delay to treatment of greater than 24 hours. Risk factors associated with greater than 6- and 24-hour delay on univariate and multivariate logistic regression were age, head or thoracic injury with Abbreviated Injury Score greater than 2, and presentation between 6 pm and 2 am. Level I and university hospitals carry a greater risk of delay that was independent of injury severity in multivariate analysis.

CONCLUSIONS:

A significant percentage of patients with open tibia fractures undergo their first surgical intervention of D&I greater than 6 hours after presentation to the emergency room. Patients with delayed D&I have more severe injuries, are treated at university or Level I centers, and present later in the day.

PMID:
21278609
DOI:
10.1097/BOT.0b013e3181e3dff1
[Indexed for MEDLINE]

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