Review Question - QID 214019

Implementation of a multidisciplinary training program for the treatment of open fractures has been associated with reduced timing to antibiotic administration.

Open fractures are typically the result of a high energy injury that causes the bone to communicate with the external environment. These injuries require immediate IV antibiotic prophylaxis followed by urgent irrigation and debridement to minimize infectious complications. A delay of greater than 3 hours to antibiotic administration has been associated with increased infection rates. A multidisciplinary training program for the treatment of open fractures has been associated with decreased timing to IV antibiotic administration.

Harper et al. performed a retrospective study of 117 patients presenting with open fractures to a level 1 trauma center. They reported that patients that presented as a trauma activation received antibiotics an average of 14 minutes from arrival, whereas open fractures that presented as non-trauma visits received antibiotics at an average of 53 minutes from arrival. They concluded that patients received antibiotics significantly faster for open fractures when evaluated by a trauma trained surgeon.

Johnson et al. performed a retrospective cohort study evaluating the effect of a multidisciplinary training group for the treatment of open fractures. They reported a significant decrease in time to antibiotic administration after implementation of the protocol, 123.1 minutes compared to 35.7 minutes. They concluded that the multidisciplinary protocol significantly reduced the time to antibiotic prophylaxis administration for patients with open fractures.

Collinge et al. performed a retrospective cohort study of 298 open fractures before and after implementation of an open fracture performance improvement program. They reported a decrease in time to antibiotic administration from 70.5 minutes to 32.4 minutes, also there was a decreased time to physician evaluation from 6.5 minutes to 4.5 minutes. They concluded that a multidisciplinary improvement program decreased the timing of antibiotic administration for open fractures.

Incorrect Answers:
Answer 1: Multi-trauma patients would benefit from damage control orthopedic care. As such, a multidisciplinary training program would not affect the rate of early total care in multi-trauma patients.
Answer 2: Multidisciplinary training programs for the treatment of open fractures does not affect the time to evaluation by a trauma surgeon.
Answer 4: Length of hospital stay has not been associated with multidisciplinary training for the management of open fractures.
Answer 5: Timing of surgical clearance has not been associated with multidisciplinary training for the management of open fractures.