Rodarte Patricia, O'Marr Jamieson, Haonga Billy, Patrick Deogratias, Niknam Kian, Urva Mayur, Cortez Abigail, Metsemakers Willem-Jan, Shearer David, Morshed Saam
Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA, USA.
Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
Injury. 2024 Feb;55(2):111179. doi: 10.1016/j.injury.2023.111179. Epub 2023 Nov 7.
Fracture-related infections (FRIs) are a major cause of trauma-associated morbidity worldwide. In 2018, an expert group supported by the AO Foundation, European Bone and Joint Infection Society developed a consensus definition of FRI. Still, there is limited knowledge on the applicability of this definition in low- and middle-income countries (LMICs). Given the unique barriers that cause low follow-up rates for orthopaedic trauma patients in LMICs, this study aims to evaluate the diagnostic performance of a telephone questionnaire in identifying patients with FRIs after open tibia fracture fixation in Tanzania.
Patients from a randomized controlled trial investigating the infection prevention benefit of locally applied gentamycin for open tibial fractures were included. Patients completed FRI based telephone questionnaires 7-10 days prior to scheduled follow-ups at 6 weeks, 3 months, 6 months, 9 months, and 1 year. The questionnaire included two "confirmatory" criteria questions for FRI (i.e., open wound and purulent drainage) and three "suggestive" criteria questions (i.e., wound drainage, fever, and warmth). Contingency tests were performed to identify the sensitivity and specificity between answers and adjudicated FRI diagnoses at the corresponding in-person follow-up. Data was analysed using STATA version 15.0 and MedCalc's online diagnostic test calculator.
There were a total of 234 complete questionnaires and 85 unique patients included. The sensitivity and specificity of having any positive answer in the questionnaire was highest at 6 months (100 % and 92.5 %, respectively). For all time-points pooled, sensitivity was 71.4 % and specificity was 93.0 %. Drainage had the highest sensitivity (71.4 %) while fever had the highest specificity (99.6 %). For confirmatory criteria, sensitivity was 14.3 % and specificity was 96.0 %. Contrastingly, the sensitivity for suggestive criteria was higher (71.4 %), with a similar specificity (93.8 %).
Our study indicates that telephone questionnaires have adequate diagnostic performance when assessing FRIs. The presence of drainage identified the majority of patients with FRI, and specificities were high across confirmatory and suggestive criteria. Our study is one of the first to evaluate telephone questionnaires as a diagnostic tool for FRIs in patients with open tibia fractures in a LMIC hospital and validates the FRI consensus definition criteria.
骨折相关感染（FRI）是全球创伤相关发病的主要原因。2018年，由AO基金会、欧洲骨与关节感染学会支持的一个专家组制定了FRI的共识定义。然而，关于该定义在低收入和中等收入国家（LMIC）的适用性的知识仍然有限。鉴于导致LMIC国家骨科创伤患者随访率低的独特障碍，本研究旨在评估电话问卷在识别坦桑尼亚开放性胫骨骨折内固定术后FRI患者方面的诊断性能。
纳入一项随机对照试验的患者，该试验研究局部应用庆大霉素预防开放性胫骨骨折感染的益处。患者在计划于6周、3个月、6个月、9个月和1年进行的随访前7 - 10天完成基于FRI的电话问卷。问卷包括两个FRI的“确诊”标准问题（即开放性伤口和脓性引流）和三个“提示性”标准问题（即伤口引流、发热和局部发热）。进行列联检验以确定答案与相应现场随访时判定的FRI诊断之间的敏感性和特异性。使用STATA 15.0版和MedCalc的在线诊断测试计算器进行数据分析。
总共纳入234份完整问卷和85名独特患者。问卷中任何一个阳性答案的敏感性和特异性在6个月时最高（分别为100%和92.5%）。综合所有时间点，敏感性为71.4%，特异性为93.0%。引流的敏感性最高（71.4%），而发热的特异性最高（99.6%）。对于确诊标准，敏感性为14.3%，特异性为96.0%。相比之下，提示性标准的敏感性较高（71.4%），特异性相似（93.8%）。
我们的研究表明，电话问卷在评估FRI时具有足够的诊断性能。引流的存在识别出了大多数FRI患者，确诊和提示性标准的特异性都很高。我们的研究是首批评估电话问卷作为LMIC医院开放性胫骨骨折患者FRI诊断工具之一，并验证FRI共识定义标准的研究之一。
