Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California.
Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California.
J Surg Res. 2020 May;249:91-98. doi: 10.1016/j.jss.2019.12.011. Epub 2020 Jan 8.
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.
创伤后常发生胫骨骨折。先前的研究表明，治疗延迟与不良预后相关。我们的一部分患者是从墨西哥转运过来的，这给及时治疗带来了障碍。我们假设从墨西哥过境的胫骨骨折患者的治疗会延迟，随后的结果会更差。
回顾性分析了一家获得美国外科医师学院认证的 1 级创伤中心的创伤登记处，对 2010 年至 2015 年期间所有因胫骨骨折入院的患者进行了研究。数据收集包括人口统计学、受伤国家、损伤特征、干预措施、并发症和结果。患者被分为在美国受伤和在墨西哥受伤的两组，比较两组患者的差异。
共确定了 498 名患者，其中 440 名来自美国，58 名来自墨西哥。总体而言，墨西哥患者的受伤程度更严重，损伤严重程度评分更高，头和胸部区域的简明损伤评分≥3 的患者比例更高。墨西哥患者从受伤到入院的时间更长，入院后开放性骨折清创和手术固定的时间也更长。对仅胫骨骨折（其他系统简明损伤评分<3）患者的亚组分析显示，从到达治疗到治疗开始的时间和损伤严重程度评分不再有统计学差异。
从墨西哥过境的胫骨骨折患者在入院时间和从入院到手术治疗的时间上存在延迟，尽管这主要是由于其他严重损伤。需要不断开发系统，以尽量减少治疗延误并优化结果。
