Aims The best time for definitive orthopaedic care is often unclear in patients with multiple injuries. The objective of this study was make a prospective assessment of the safety of our early appropriate care (EAC) strategy and to evaluate the potential benefit of additional laboratory data to determine readiness for surgery.
Patients and Methods A cohort of 335 patients with fractures of the pelvis, acetabulum, femur, or spine were included. Patients underwent definitive fixation within 36 hours if one of the following three parameters were met: lactate < 4.0 mmol/L; pH ≥ 7.25; or base excess (BE) ≥ -5.5 mmol/L. If all three parameters were met, resuscitation was designated full protocol resuscitation (FPR). If less than all three parameters were met, it was designated an incomplete protocol resuscitation (IPR). Complications were assessed by an independent adjudication committee and included infection; sepsis; PE/DVT; organ failure; pneumonia, and acute respiratory distress syndrome (ARDS).
Results In total, 66 patients (19.7%) developed 90 complications. An historical cohort of 1441 patients had a complication rate of 22.1%. The complication rate for patients with only one EAC parameter at the point of protocol was 34.3%, which was higher than other groups (p = 0.041). Patients who had IPR did not have significantly more complications (31.8%) than those who had FPR (22.6%; p = 0.078). Regression analysis showed male gender and injury severity score to be independent predictors of complications.
Conclusions This study highlights important trends in the IPR and FPR groups, suggesting that differences in resuscitation parameters may guide care in certain patients; further study is, however, required. We advocate the use of the existing protocol, while research is continued for high-risk subgroups.
Cite this article: Bone Joint J 2017;99-B:122–7.
D. S. Weinberg: Project design, Data collection, Data analysis, Manuscript preparation, Critically reviewed and edited the final manuscript.
A. S. Narayanan: Data collection, Data analysis, Critically reviewed and edited the final manuscript.
T. A. Moore: Project design, Data collection, Critically reviewed and edited the final manuscript
H. A. Hallier: Organised the research team, Conceptualised the study, Project design, Manuscript preparation, Critically reviewed and edited the final manuscript.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by P. Page and first proof edited by A. C. Ross.
Supplementary material. Further information regarding demographic groups and advanced statistical comparisons is available alongside the online version of this article at www.bjj.boneandjoint.org.uk
- Received May 12, 2016.
- Accepted September 27, 2016.
- ©2017 The British Editorial Society of Bone & Joint Surgery