Kadi Bacil, Condeni Melanie Smith, Morrisette Taylor, Bell Carolyn, Hamby Aaron, Pollander Abby
Department of Pharmacy, The Ohio State Wexner Medical Center, Columbus, OH, USA.
Department of Pharmacy, Medical University of South Carolina Health, Charleston, SC, USA.
Am J Health Syst Pharm. 2025 May 23;82(Supplement_3):S2915-S2921. doi: 10.1093/ajhp/zxae398.
Open fractures are associated with significant morbidity after trauma, which is driven, in part, by infection. Current literature and guidelines recommend that this patient population receive antimicrobial prophylaxis within 1 hour of emergency department (ED) arrival to minimize the risk of infection. The primary aim of this study was to investigate whether the addition of a trauma response to a pharmacy resident on-call program resulted in antibiotic administration within 1 hour of presentation to a higher proportion of patients with open fractures.
This was a retrospective, observational, quasi-experimental analysis that was conducted at an academic medical facility with a level 1 trauma center for patients presenting to the ED from January 2019 to December 2020 (preimplementation period) and from January 2021 to December 2022 (postimplementation period). Patients were included if they were 18 years of age or older and presented to the ED with an open fracture(s). Patients with independent fractures of fingers and those who died in route to or in the ED were excluded. The primary outcome was the proportion of patients with antibiotic administration within 1 hour of ED presentation for patients with open extremity fractures.
A total of 292 patients met the eligibility criteria (49% in the preimplementation group and 51% in the postimplementation group). Patients were predominantly male (61% vs 58%), with an overall median age of 46 years. Following implementation of the on-call pharmacy resident trauma response, a significantly higher proportion of patients received antibiotics within 1 hour of presentation (70% vs 83%; P = 0.019). The median (interquartile range) time to antimicrobial administration was also significantly shorter in the postimplementation group (31 [16-68] minutes vs 19 [10-50] minutes; P = 0.005).
The addition of a 24-hour on-call pharmacy resident response in the ED was associated with improved antibiotic administration within 1 hour of presentation in patients with open fractures.
开放性骨折与创伤后严重的发病率相关，部分原因是感染。当前的文献和指南建议，这类患者群体应在抵达急诊科（ED）后1小时内接受抗菌药物预防，以将感染风险降至最低。本研究的主要目的是调查在药房住院医师随叫随到计划中增加创伤响应是否能使更高比例的开放性骨折患者在就诊后1小时内接受抗生素治疗。
这是一项回顾性、观察性、准实验分析，在一家设有一级创伤中心的学术医疗设施中进行，研究对象为2019年1月至2020年12月（实施前阶段）以及2021年1月至2022年12月（实施后阶段）到急诊科就诊的患者。纳入标准为年龄在18岁及以上且因开放性骨折到急诊科就诊的患者。手指独立骨折患者以及在前往急诊科途中或在急诊科死亡的患者被排除。主要结局是开放性四肢骨折患者在急诊科就诊后1小时内接受抗生素治疗的患者比例。
共有292名患者符合纳入标准（实施前组占49%，实施后组占51%）。患者以男性为主（分别为61%和58%），总体中位年龄为46岁。在实施药房住院医师创伤响应后，就诊后1小时内接受抗生素治疗的患者比例显著更高（70%对83%；P = 0.019）。实施后组抗菌药物给药的中位（四分位间距）时间也显著缩短（31[16 - 68]分钟对19[10 - 50]分钟；P = 0.005）。
在急诊科增加24小时随叫随到的药房住院医师响应与开放性骨折患者就诊后1小时内抗生素给药情况的改善相关。
