A. Brito1, L. N. Godat1, T. W. Costantini1, J. Doucet1, A. M. Smith1, A. E. Berndtson1 1University Of California – San Diego,Surgery,San Diego, CA, USA
Introduction: Tibia fractures are commonly seen after injury and often require operative fixation. Prior studies have shown that delays in care for treatment of tibia fractures are associated with poor functional outcomes. A sub-population of patients admitted to our trauma center are transferred from Mexico, adding barriers to prompt care for their injuries. We hypothesized that patients with tibia fractures transferred from Mexico would have delays in care and subsequently worse outcomes.
Methods: The trauma registry of an ACS-verified level 1 trauma center was retrospectively reviewed for all tibia fractures admitted from 2010-2015. Data collection included demographics, country of injury, open vs. closed fracture, Gustilo classification, operative interventions required, complications and outcomes. Patients were then subdivided into those injured in the USA and in Mexico (MEX) and the two groups were compared.
Results: A total of 497 patients were identified, 439 from the USA and 58 transferred from MEX. MEX patients were more severely injured overall, with higher injury severity scores (Table) as well as a higher percentage of patients with AIS scores ≥ 3 for both Head (USA 14.4% vs. MEX 29.3%, p = 0.007) and Chest (USA 14.4% vs. MEX 31.0%, p = 0.004) regions. MEX patients had longer times from injury to admission, as well as increased times to both debridement and operative fixation after admission (Table). There was no difference in Gustilo classification of open fractures between groups. MEX patients were more likely to have a venous thromboembolism (USA 6.7% vs. MEX 15.6%, P = 0.003) or undergo lower extremity amputation (USA 0.91% vs. MEX 6.9%, p = 0.008). Subgroup analysis of patients with isolated tibia fractures (other AIS < 3) still demonstrated longer times from arrival to both debridement and fixation in patients from MEX, though ISS was no longer statistically different (median ± IQR, USA 10 ± 8 vs. MEX 9 ± 4, p = 0.625).
Conclusion: Patients transferred from MEX for treatment of tibia fractures have resultant delays in time from injury to admission, but also have a longer period from admission to definitive care of their fracture. Patients transferred from MEX also had worse outcomes, including increased rates of VTE and amputation compared to those injured in the US. Ongoing systems development is required to improve processes for transfer from Mexico to the US, when needed, in order to minimize delays in care and optimize outcomes.
