Isolated injury, Charlson Comorbidity Index, and transfer from another facility are associated with delay in antibiotic administration: a retrospective study of 963 patients with open fractures.

Purpose: To identify factors associated with delays in administration and pharmacy and nursing preparation of antibiotics for patients with open fractures. Design: Retrospective review. Setting: Level I trauma center. Patients: Nine hundred sixty-three adults with open fractures administered antibiotics. Main Outcome Measurements: Delay in antibiotic administration greater than 66 minutes from arrival and significant pharmacy-related and nursing-related delay. Results: Isolated injury, Charlson Comorbidity Index, and transfer from another facility were associated with delay in antibiotic administration greater than 66 minutes. Injury Severity Score, transfer, and trauma team activation were associated with pharmacy-related or nursing-related delay. Conclusion: Interventions to reduce antibiotic administration time for open fractures should focus on early identification of open fractures and standardization of antibiotic protocols to ensure timely administration even in complex or resource-scarce care situations. Level of Evidence: Prognostic level III.

Most orthopaedic trauma patients are using the internet, but do you know where they're going?

PURPOSE: The Internet is a resource that patients can use to learn about their injuries, treatment options, and surgeon. Previously, it was demonstrated that orthopaedic trauma patients are unlikely to use a reliable, provided source. It is unknown however, if patients are seeking information from elsewhere. The purpose of this study was to determine if orthopaedic trauma patients utilize the Internet and what websites are utilized. Our hypothesis was that the majority of patients use the Internet and when they do, are unlikely to use a reliable source. METHODS: Orthopaedic trauma patients were surveyed in clinic at a Level I trauma center in the United States. The survey queried demographics, injury information, Internet access, and eHealth Literacy Scale (eHEALS). Data were analyzed using t-tests, Chi-squared tests, and a multivariate logistic regression, as appropriate. RESULTS: 138 patients with a mean age of 47.1 years (95% confidence interval: 44.0-50.3; 51.1% female) were included in the analysis. Despite 94.1% reporting access, only 55.8% of trauma patients used the Internet for information about their injury. Of those, 64.5% used at least one unreliable source. WebMD (54.8%) was the highest utilized website. Age, sex, employment, and greater eHEALS score were associated with increased Internet use (p<0.001). CONCLUSION: The Internet has potential to be a useful, low cost, and readily available informational source for orthopaedic trauma patients. This study illustrates that a majority of patients seek information from the Internet after their injury, including unreliable websites like Wikipedia and Facebook. Our study emphasizes the need for active referral to trusted websites and initiation of organizational partnerships (e.g. OTA/AAOS) with common content providers (e.g. WebMD) to provide patients with accurate information about their injury and treatment. LEVEL OF EVIDENCE: Prognostic, Level II.