The Effects of Cross-Border Transport on Patients With Tibia Fractures.
Adult
Debridement
/ statistics & numerical data
Female
Fracture Fixation
/ statistics & numerical data
Fractures, Open
/ diagnosis
Humans
Injury Severity Score
Male
Mexico
Middle Aged
Patient Admission
/ statistics & numerical data
Registries
/ statistics & numerical data
Retrospective Studies
Tibial Fractures
/ diagnosis
Time-to-Treatment
/ statistics & numerical data
Transportation of Patients
/ statistics & numerical data
Trauma Centers
/ statistics & numerical data
Triiodothyronine
/ analogs & derivatives
United States
Young Adult
Border health
Disparities
Global health
Mexico
Tibia fracture
Trauma
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
23
07
2019
revised:
12
12
2019
accepted:
12
12
2019
pubmed:
12
1
2020
medline:
1
8
2020
entrez:
12
1
2020
Statut:
ppublish
Résumé
Tibia fractures are common after trauma. Prior studies have shown that delays in treatment are associated with poor outcomes. A subpopulation of our patients are transported from Mexico, adding barriers to prompt care. We hypothesized that patients with tibia fractures crossing from Mexico would have delays in treatment and subsequently worse outcomes. The trauma registry of an American College of Surgeons-verified level 1 trauma center was retrospectively reviewed for all tibia fractures admitted from 2010 to 2015. Data collection included demographics, country of injury, characterization of injuries, interventions, complications, and outcomes. Patients were subdivided into those injured in the United States and in Mexico, and the two groups were compared. A total of 498 patients were identified, 440 from the United States and 58 from Mexico. Mexico patients were more severely injured overall, with higher injury severity scores and a higher percentage of patients with abbreviated injury scale scores ≥3 for both head and chest regions. Mexico patients had longer times from injury to admission, as well as increased times to both debridement of open fractures and operative fixation after admission. On subgroup analysis of patients with isolated tibia fractures (other system abbreviated injury scale < 3), times from arrival to treatment and injury severity score were no longer statistically different. Patients crossing the border from Mexico with tibia fractures have delays in time to admission and from admission to operative management, although this is primarily due to other severe injuries. Ongoing systems development is required to minimize delays in care and optimize outcomes.
Sections du résumé
BACKGROUND
Tibia fractures are common after trauma. Prior studies have shown that delays in treatment are associated with poor outcomes. A subpopulation of our patients are transported from Mexico, adding barriers to prompt care. We hypothesized that patients with tibia fractures crossing from Mexico would have delays in treatment and subsequently worse outcomes.
METHODS
The trauma registry of an American College of Surgeons-verified level 1 trauma center was retrospectively reviewed for all tibia fractures admitted from 2010 to 2015. Data collection included demographics, country of injury, characterization of injuries, interventions, complications, and outcomes. Patients were subdivided into those injured in the United States and in Mexico, and the two groups were compared.
RESULTS
A total of 498 patients were identified, 440 from the United States and 58 from Mexico. Mexico patients were more severely injured overall, with higher injury severity scores and a higher percentage of patients with abbreviated injury scale scores ≥3 for both head and chest regions. Mexico patients had longer times from injury to admission, as well as increased times to both debridement of open fractures and operative fixation after admission. On subgroup analysis of patients with isolated tibia fractures (other system abbreviated injury scale < 3), times from arrival to treatment and injury severity score were no longer statistically different.
CONCLUSIONS
Patients crossing the border from Mexico with tibia fractures have delays in time to admission and from admission to operative management, although this is primarily due to other severe injuries. Ongoing systems development is required to minimize delays in care and optimize outcomes.
Identifiants
pubmed: 31926401
pii: S0022-4804(19)30858-3
doi: 10.1016/j.jss.2019.12.011
pii:
doi:
Substances chimiques
Triiodothyronine
06LU7C9H1V
3,3',5-triiodothyroacetic acid
29OQ9EU4R1
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
91-98Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.