Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec 1;1(1):e000041.
doi: 10.1136/tsaco-2016-000041. eCollection 2016.

Outcome of Femoral Fractures Care as a Measure of Trauma Care Between Level I and Level II Trauma Systems in Israel

Collaborators, Affiliations
Free PMC article

Outcome of Femoral Fractures Care as a Measure of Trauma Care Between Level I and Level II Trauma Systems in Israel

A Khoury et al. Trauma Surg Acute Care Open. .
Free PMC article

Abstract

Background: Our hypothesis in this study was that the outcome of patients with femur fractures would be favorable in a level I trauma center (LITC).

Methods: A prospective multicenter cohort study. 5 LITC and 6 regional (level II) trauma centers (RTCs) were enrolled to participate in the study. A total of 238 patients suffering from a femoral fracture were recruited to the study. 125 patients were treated in LITCs and 113 in RTCs. Data were extracted from the emergency medical services ambulances, emergency department records, patient hospitalization and discharge records, operating room records, and the national trauma registry (for LITCs). A study questionnaire was administered to all participating patients at discharge, 6 weeks and 6 months postoperatively. The following parameters were studied: mechanism of injury, time from injury to the hospital, Injury Severity Score, classification of femoral fracture, additional injuries, medical history, time to surgery, implant type, skill level of the surgical team, type of anesthesia, length of stay and intensive care unit (ICU) stay, postoperative and intraoperative complications and mortality.

Results: There was a significant difference in the modality of patient transfer between the 2 study groups-with the LITC receiving more patients transported by helicopters or medical intensive care. Time to surgery from admission was shorter in the LITC. Length of stay, ICU stay, and mortality were similar. In the LITCs, 47% of the procedures were performed by residents without the supervision of an attending surgeon, and in the RTCs 79% of the procedures were performed with an senior orthopaedic surgeon. Intraoperative and immediate complication rates were similar among the 2 groups.

Conclusions: A femoral shaft fracture can be successfully treated in an LITC and RTC in the state of Israel. Both research and policy implementation works are required. Also, a more detailed outcome analysis and triage criteria for emergency are desired.

Level of evidence: II.

Keywords: Efficiency; femur fracture; health care policy.

Conflict of interest statement

Competing interests: None declared.

Similar articles

See all similar articles

References

    1. Trauma care systems quality improvement guidelines. American College of Emergency Physician. Ann Emerg Med 1992;21:736–9. - PubMed
    1. Resources for optimal care of the injured patient: an update. Task Force of the Committee on Trauma, American College of Surgeons. Bull Am Coll Surg 1990;75:20–9. - PubMed
    1. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006;354:366–78. doi:10.1056/NEJMsa052049 - DOI - PubMed
    1. MacKenzie EJ, Weir S, Rivara FP, Jurkovich GJ, Nathens AB, Wang W, Scharfstein DO, Salkever DS. The value of trauma center care. J Trauma 2010;69:1–10. doi:10.1097/TA.0b013e3181e03a21 - DOI - PubMed
    1. Ben Abraham R, Heruti RJ, Abramovitch Y, Marganit B, Shemer J, Stein M. Structure and process components of trauma care services in Israeli acute-care hospitals. Injury 1998;29:43–6. - PubMed

LinkOut - more resources

Feedback