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Trauma Surgery Program Abstracts

Purpose: To assess the performance of Middlemore Hospital ’ s trauma care system using debridement of open lower limb fractures as a key performance indicator. Methodology: International literature and expert opinion has defi ned the gold standard as within six hours. We conducted a retrospective audit of patients treated at Middlemore Hospital, Auckland, New Zealand with open lower limb fractures between January 2007 and December 2010. We excluded patients under the age of 18 and ankle or foot fractures. We collected data from our electronic hospital databases and patient notes. Data points included age, data and time of accident, Injury Severity Score (ISS), time points of; arrival in emergency department, called for theatre, arrived in theatre, operation start. A further end point included the complication of deep-seated infection. Results: There were 102 patients with open lower limb fractures. The mean age was 43.5 (SD 15.2). The eldest patient was 82. Their mean ISS was 7.6 (SD 6.0) with a range from 4 to 34. The mean wait from injury to operation start was 7.7 hours (SD 4.0). The longest wait for surgery was 30 hours and the shortest 2.4 hours. Only 38 (37%) patients had their surgery within 6 hours. Four patients suffered from deep-seated infections. Conclusion: Currently only a small proportion of patients achieve operative debridement of their open lower limb fractures within the gold standard.