Impact of establishing a level-1 trauma center for lower extremity trauma: a 4-year experience
Dublin Core
Title
Impact of establishing a level-1 trauma center for lower extremity trauma: a 4-year experience
Subject
Amputation, Limb salvage, Lower limb, Open fracture, Trauma center
Description
Purpose: A multidisciplinary approach is essential for trauma patients’ treatment, particularly for cases with open
lower extremity fractures, which are considered major traumas requiring a comprehensive approach. Recently, the
social demand for severe-trauma centers has increased. This study analyzed the clinical impact of establishing a
trauma center for the treatment of open lower extremity fractures.
Methods: A retrospective chart review was conducted for trauma patients admitted to our hospital. Patients were
classifed into two groups: before (January 2014–December 2015, 178 patients) and after establishment of a Level-1
trauma center (January 2017–December 2018, 125 patients). We included patients with open fracture below the knee
level and Gustilo type II/III, but excluded those with life-threatening trauma that afected the treatment choice.
Results: Total 273 patient were included in this study, initial infection was signifcantly more common and external
fxator application signifcantly less in post-center establishment group. The time to emergency operation decreased
signifcantly from 13.89±17.48 to 11.65±19.33 h post-center setup. By multivariate analysis, the decreased primary
amputation and increased limb salvage was attributed to establishment of the trauma center.
Conclusion: With the establishment of the Level-1 trauma center, limbs of patients with open lower extremity
fractures could be salvaged, and the need for primary amputation was decreased. Early control of initial open wound
infection and minimizing external fxator use allowed early soft tissue reconstruction. The existence of the center
ensured a shorter interval to emergency operation and facilitated interdepartmental cooperation, which promoted
active limb salvage and contributed to patients’ quality of life.
lower extremity fractures, which are considered major traumas requiring a comprehensive approach. Recently, the
social demand for severe-trauma centers has increased. This study analyzed the clinical impact of establishing a
trauma center for the treatment of open lower extremity fractures.
Methods: A retrospective chart review was conducted for trauma patients admitted to our hospital. Patients were
classifed into two groups: before (January 2014–December 2015, 178 patients) and after establishment of a Level-1
trauma center (January 2017–December 2018, 125 patients). We included patients with open fracture below the knee
level and Gustilo type II/III, but excluded those with life-threatening trauma that afected the treatment choice.
Results: Total 273 patient were included in this study, initial infection was signifcantly more common and external
fxator application signifcantly less in post-center establishment group. The time to emergency operation decreased
signifcantly from 13.89±17.48 to 11.65±19.33 h post-center setup. By multivariate analysis, the decreased primary
amputation and increased limb salvage was attributed to establishment of the trauma center.
Conclusion: With the establishment of the Level-1 trauma center, limbs of patients with open lower extremity
fractures could be salvaged, and the need for primary amputation was decreased. Early control of initial open wound
infection and minimizing external fxator use allowed early soft tissue reconstruction. The existence of the center
ensured a shorter interval to emergency operation and facilitated interdepartmental cooperation, which promoted
active limb salvage and contributed to patients’ quality of life.
Creator
Min Ji Kim, Kyung Min Yang, Hyung Min Hahn, Hyoseob Lim and Il Jae Lee
Publisher
BMC Emergency Medicine
Date
(2022) 22:123
Contributor
Fajar Bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Min Ji Kim, Kyung Min Yang, Hyung Min Hahn, Hyoseob Lim and Il Jae Lee, “Impact of establishing a level-1 trauma center for lower extremity trauma: a 4-year experience,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/4141.