title: [Current standard of care for initial management of open fractures in emergency departments : A nationwide survey in German trauma centers].
abstract: BACKGROUND
  Limiting the morbidity of open fractures requires highly specific initial treatment. In addition to a stringent surgical strategy, correct antibiotic prophylaxis seems to be associated with an improved outcome. In the current literature, the duration and type of antibiotic prophylaxis are under discussion. The aim of the study was to survey the current initial treatment regimes for open fractures in German emergency departments.
  
  
  METHODS
  With an online-based anonymous 16-item questionnaire all 3006 members of the German Trauma Society were surveyed. A total of 585 questionnaires (19.5 %) were returned completed. This article presents a descriptive analysis of the current state of treatment.
  
  
  RESULTS
  Mainly specialists (35 %), senior physicians (30 %) and chief physicians (17 %) answered as well as interns (8 %) and out-patient practitioners (10 %). Of the participants 65 % did not accept the classification of emergency services; however, 93 % carried out urgent or emergency surgery, 84 % started an antibiotic prophylaxis in the emergency department and 63 % used a standard operating procedure (SOP). A total of 60 % used 1 antibiotic drug, 25 % used 2 and 15 % used 3 or more substances. An antibiotic treatment for more than 3 days was performed by 60 % of participants.
  
  
  CONCLUSIONS
  The early initiation of antibiotic prophylaxis seems to be the standard practice in German emergency departments as well as early surgery. Strategies to improve the communication between prehospital and in-hospital teams, as well as graded antibiotic prophylaxis depending on the severity of soft tissue damage are needed.
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Lehrstuhl der Universität Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimerstr. 200, 51109, Köln, Deutschland. reithg@kliniken-koeln.de.
authors.forename: G
authors.initials: G
authors.lastname: Reith
authors.affiliation: Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Goethe-Universität, Frankfurt, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Wyen
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Lehrstuhl der Universität Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimerstr. 200, 51109, Köln, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Wafaisade
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Lehrstuhl der Universität Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimerstr. 200, 51109, Köln, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Paffrath
authors.affiliation: Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Flohé
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Lehrstuhl der Universität Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimerstr. 200, 51109, Köln, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Bouillon
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Lehrstuhl der Universität Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimerstr. 200, 51109, Köln, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Maegele
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Lehrstuhl der Universität Witten/Herdecke am Klinikum Köln-Merheim, Ostmerheimerstr. 200, 51109, Köln, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Probst
mesh_terms: D019072:Antibiotic Prophylaxis / Q000592:standards / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D005597:Fractures, Open / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D059039:Standard of Care / Q000706:statistics & numerical data*; D014218:Triage / Q000592:standards / Q000706:statistics & numerical data
keywords: Antibiotic prophylaxis; Indications for surgery; Standard operating procedure; Substance selection; Treatment duration