Impact of establishing a level-1 trauma center for lower extremity trauma: a 4-year experience

Abstract

PURPOSE: A multidisciplinary approach is essential for trauma patients' treatment, particularly for cases with open lower extremity fractures, which are considered major traumas requiring a comprehensive approach. Recently, the social demand for severe-trauma centers has increased. This study analyzed the clinical impact of establishing a trauma center for the treatment of open lower extremity fractures. METHODS: A retrospective chart review was conducted for trauma patients admitted to our hospital. Patients were classified into two groups: before (January 2014-December 2015, 178 patients) and after establishment of a Level-1 trauma center (January 2017-December 2018, 125 patients). We included patients with open fracture below the knee level and Gustilo type II/III, but excluded those with life-threatening trauma that affected the treatment choice. RESULTS: Total 273 patient were included in this study, initial infection was significantly more common and external fixator application significantly less in post-center establishment group. The time to emergency operation decreased significantly from 13.89 +/- 17.48 to 11.65 +/- 19.33 h post-center setup. By multivariate analysis, the decreased primary amputation and increased limb salvage was attributed to establishment of the trauma center. CONCLUSION: With the establishment of the Level-1 trauma center, limbs of patients with open lower extremity fractures could be salvaged, and the need for primary amputation was decreased. Early control of initial open wound infection and minimizing external fixator use allowed early soft tissue reconstruction. The existence of the center ensured a shorter interval to emergency operation and facilitated interdepartmental cooperation, which promoted active limb salvage and contributed to patients' quality of life.