TY - JOUR
T1 - Early fracture fixation may be 'just fine' after head injury
T2 - No difference in central nervous system outcomes
AU - Scalea, Thomas M.
AU - Scott, Jane D.
AU - Brumback, Robert J.
AU - Burgess, Andrew R.
AU - Mitchell, Kimberly A.
AU - Kufera, Joseph A.
AU - Turen, Clifford
AU - Champion, Howard R.
PY - 1999/5
Y1 - 1999/5
N2 - Background: Recent reports suggest that early fracture fixation worsens central nervous system (CNS) outcomes. We compared discharge Glasgow Coma Scale (GCS) scores, CNS complications, and mortality of severely injured adults with head injuries and pelvic/lower extremity fractures treated with early versus delayed fixation. Methods: Using trauma registry data, records meeting preselected inclusion criteria from the years 1991 to 1995 were examined. We identified 171 patients aged 14 to 65 years (mean age, 32.7 years) with head injuries and fractures who underwent early fixation (≤24 hours after admission) (n = 147) versus delayed fixation (>24 hours after admission) (n = 24). Results: Patients were severely injured, with a mean admission GCS score of 9.1, Revised Trauma Score of 6.2, Injury Severity Score of 38, median intensive care unit length of stay of 16.5 days, and hospital length of stay of 23 days. No differences between groups were found by age, admission GCS score, Injury Severity Score, Revised Trauma Score, intensive care unit length of stay, hospital length of stay, shock, vasopressors, major nonorthopedic operative procedures, total intravenous fluids or blood products, or mortality rates. In survivors, no differences in discharge GCS scores or CNS complications were found. Conclusion: We found no evidence to suggest that early fracture fixation negatively influences CNS outcomes or mortality.
AB - Background: Recent reports suggest that early fracture fixation worsens central nervous system (CNS) outcomes. We compared discharge Glasgow Coma Scale (GCS) scores, CNS complications, and mortality of severely injured adults with head injuries and pelvic/lower extremity fractures treated with early versus delayed fixation. Methods: Using trauma registry data, records meeting preselected inclusion criteria from the years 1991 to 1995 were examined. We identified 171 patients aged 14 to 65 years (mean age, 32.7 years) with head injuries and fractures who underwent early fixation (≤24 hours after admission) (n = 147) versus delayed fixation (>24 hours after admission) (n = 24). Results: Patients were severely injured, with a mean admission GCS score of 9.1, Revised Trauma Score of 6.2, Injury Severity Score of 38, median intensive care unit length of stay of 16.5 days, and hospital length of stay of 23 days. No differences between groups were found by age, admission GCS score, Injury Severity Score, Revised Trauma Score, intensive care unit length of stay, hospital length of stay, shock, vasopressors, major nonorthopedic operative procedures, total intravenous fluids or blood products, or mortality rates. In survivors, no differences in discharge GCS scores or CNS complications were found. Conclusion: We found no evidence to suggest that early fracture fixation negatively influences CNS outcomes or mortality.
KW - Adult trauma
KW - Fracture fixation
KW - Head injury
KW - Health services research
KW - Multiple injuries
KW - Timing of fracture fixation
KW - Trauma registry
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U2 - 10.1097/00005373-199905000-00012
DO - 10.1097/00005373-199905000-00012
M3 - Article
C2 - 10338401
AN - SCOPUS:0032957115
SN - 0022-5282
VL - 46
SP - 839
EP - 846
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 5
ER -