Helicopter Emergency Medical Services Crew Administration of Antibiotics for Open Fractures

The effect of timing of antibiotic delivery on infection rates related to open limb fractures: a systematic review

“…Titles and abstracts were screened for potentially eligible studies and 24 full papers obtained and assessed for inclusion against the eligibility criteria (figure 1). Eight studies were included 2 6 12 23–27. Three studies28–30 were excluded because they were abstracts reporting on the same cohort as an included study; one because it was a reply to a letter related to an included study31 and the remaining 12 studies did not meet at least one inclusion criterion 15 16 32–41…”

“…The studies were based in the UK;25 27 Australia;26 Canada and/or the USA 2 6 12 23 24. The oldest study was approximately 30 years old with the cohort running from 1983 to 198612 the most recent ran from 2010 to 2013 6.…”

“…All of the included studies assessed our primary outcome of interest, deep infection, however, there was considerable variability in how this was defined and one study reported it as part of a composite outcome 2. The other most commonly reported outcome was fracture non-union 12 23 26.…”

“…The deep infection rate ranged from 5% to 17.5%, though it is unclear whether this variation is related to characteristics of the participants, setting, the time period of the cohort or variation in the definition of infection used. Four of the studies did not undertake a multivariate analysis, either not planned or insufficient sample size, and therefore other confounding variables were not taken into consideration 2 23 25 27…”

“…The annual incidence of open long bone fractures is 11.5 per 100 000 persons per year and >70% involve the lower limb 1 2. When an open fracture occurs, the barrier provided by the skin is lost, leading to an increased risk of infection.…”