title: Delay in surgical débridement of open tibia fractures: an analysis of national practice trends.
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.
authors.affiliation: Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia PA, USA. Samir.Mehta@uphs.upenn.edu
authors.forename: Surena
authors.initials: S
authors.lastname: Namdari
authors.forename: Keith D
authors.initials: KD
authors.lastname: Baldwin
authors.forename: Paul
authors.initials: P
authors.lastname: Matuszewski
authors.forename: John L
authors.initials: JL
authors.lastname: Esterhai
authors.forename: Samir
authors.initials: S
authors.lastname: Mehta
mesh_terms: D016208:Databases, Factual; D003646:Debridement / Q000379:methods*; D005260:Female; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors