Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation

• DOI: 10.1186/s13018-015-0298-1
• Publication Date: 2015-10-01T02:50:24Z
• Authors: Heather A. Vallier; Timothy A. Moore; John J. Como; Patricia A. Wilcz...; Michael P. Steinmetz; Karl G. Wagner; Charles E. Smith; Xiao-Feng Wang; Andrea J. Dolenc
• Keywords: Trauma Center

Our group developed a protocol, entitled Early Appropriate Care (EAC), to determine timing of definitive fracture fixation based on presence and severity metabolic acidosis. We hypothesized that utilization EAC would result in fewer complications than historical cohort patients with within 36 h have those treated at later time.Three hundred thirty-five mean age 39.2 years Injury Severity Score (ISS) 26.9 380 fractures the femur (n = 173), pelvic ring 71), acetabulum 57), and/or spine 79) were prospectively evaluated. The protocol recommended if lactate <4.0 mmol/L, pH ≥7.25, or base excess (BE) ≥-5.5 mmol/L. Complications including infections, sepsis, DVT, organ failure, pneumonia, acute respiratory distress syndrome (ARDS), pulmonary embolism (PE) identified compared for early delayed cohort.All 335 achieved desired level resuscitation injury. Two sixty-nine (80%) h, 66 had violations, basis, due surgeon choice 71%. occurred 16.3% fixed 33.3% (p 0.0009). Hospital ICU stays shorter group: 9.5 versus 17.3 days 4.4 11.6 days, respectively, both p < 0.0001. This when 1443 similar 1745 (16.3 22.1%, 0.017) length stay (LOS) 0.018).Our recommends resuscitated patients. was associated LOS. recommendations are safe effective majority severely injured mechanically unstable femur, pelvis, acetabular, requiring fixation.