Current standard of care for initial management of open fractures in emergency departments. A nationwide survey in German trauma centers

Background. Limiting the morbidity of open fractures requires highly specific initial treatment. In addition to a stringent surgical strategy, correct antibiotic prophylaxis seems to be associated with an improved outcome. In the current literature, the duration and type of antibiotic prophylaxis are under discussion. The aim of the study was to survey the current initial treatment regimes for open fractures in German emergency departments. Material and methods. With an online-based anonymous 16-item questionnaire all 3006 members of the German Trauma Society were surveyed. A total of 585 questionnaires (19.5%) were returned completed. This article presents a descriptive analysis of the current state of treatment. Results. Mainly specialists (35%), senior physicians (30%) and chief physicians (17%) answered as well as interns (8%) and out-patient practitioners (10%). Of the participants 65% did not accept the classification of emergency services; however, 93% carried out urgent or emergency surgery, 84% started an antibiotic prophylaxis in the emergency department and 63% used a standard operating procedure (SOP). A total of 60% used 1 antibiotic drug, 25% used 2 and 15% used 3 or more substances. An antibiotic treatment for more than 3 days was performed by 60% of participants. Conclusion. The early initiation of antibiotic prophylaxis seems to be the standard practice in German emergency departments as well as early surgery. Strategies to improve the communication between prehospital and in-hospital teams, as well as graded antibiotic prophylaxis depending on the severity of soft tissue damage are needed.