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Meta-Analysis
. 2024 Apr;50(2):467-476.
doi: 10.1007/s00068-023-02366-x. Epub 2023 Sep 30.

Comparing outcomes following direct admission and early transfer to specialized trauma centers in open tibial fracture treatment: a systematic review and meta-analysis

Pien Gabriele Francien Joosten #  1 , Marieke Paulina Borgdorff #  2   3   4 , Matthijs Botman  5 , Mark-Bram Bouman  5 , Daphne van Embden  1 , Georgios Fredericus Giannakópoulos  1
Affiliations
Meta-Analysis

Comparing outcomes following direct admission and early transfer to specialized trauma centers in open tibial fracture treatment: a systematic review and meta-analysis

Pien Gabriele Francien Joosten et al. Eur J Trauma Emerg Surg. 2024 Apr.

Abstract

Introduction: Guidelines on the management of open tibia fractures recommend timely treatment in a limb reconstruction center which offer joint orthopedic-trauma and plastic surgery services. However, patient's transfer between centers remains inevitable. This review aims to evaluate the clinical outcomes and hospital factors for patients directly admitted and transferred patients to a limb-reconstruction center.

Methods: A research protocol adhering to PRISMA standards was established. The search included databases like MEDLINE, EMBASE, and the Cochrane library up until March 2023. Nine articles met the inclusion criteria, focusing on open tibia fractures. Exclusion criteria were experimental studies, animal studies, and case reports. Outcomes of interest were operation and infection rates, nonunion, limb salvage, and the Enneking limb score.

Results: The analysis involved data from 520 patients across nine studies published between 1990 and 2023, with the majority (83.8%) having Gustilo Anderson type III open tibia fractures. Directly admitted patients showed lower overall infection rates (RR 0.30; 95% CI 0.10-0.90; P = 0.03) and fewer deep infections (RR 0.39; 95% CI 0.22-0.68; P = 0.001) compared to transferred patients. Transferred patients experienced an average five-day delay in soft tissue closure and extended hospital stays by eight days. Patients transferred without initial surgical management underwent fewer total surgical procedures. The direct admission group displayed more favorable functional outcomes.

Conclusion: Low- to moderate-quality evidence indicates worse clinical outcomes for transferred patients compared to directly admitted patients. Early treatment in specialized limb reconstruction units is essential for improved results in the management of open tibia fractures.

Level of evidence: Therapeutic level IIa.

Keywords: Complications; Lower extremity; Open fracture; Orthoplastic; Tertiary care centers.

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Conflict of interest statement

The authors of this article declare that they have no known competing financial interests, or personal relationships that could have influenced the work and outcomes of this paper.

Figures

Fig. 1
Fig. 1
Prisma (preferred Reporting Items for Systematic Meta-Analyses). Study selection and inclusion flow diagram
Fig. 2
Fig. 2
Random effect meta-analysis of the proportion of the overall infection rates in DAP and TP after open tibia fractures. Forest plots comparing DAP and GTP groups. Horizontal lines represent 95% CIs. DAP direct admission patients, GTP general transfer patients
Fig. 3
Fig. 3
Random effect meta-analysis of the proportion of the deep infection rates in DAP and TP after open tibia fractures. Forest plots comparing DAP and GTP groups. Horizontal lines represent 95% CI. DAP direct admission patients, GTP general transfer patients
Fig. 4
Fig. 4
Random effect meta-analysis of the proportion of the secondary amputation rates in DAP and TP after open tibia fractures. Forest plots comparing DAP and GTP groups. Horizontal lines represent 95% CI. DAP direct admission patients, GTP general transfer patients
See this image and copyright information in PMC

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