Assessing The Variability Of Antibiotic Management In Patients With Open Hand Fractures Presenting To The Pediatric Emergency Department.
Sophia Gorgens, Deepa Patel, Kaitlin Keenan, Joanna Fishbein, *Francesca Bullaro
Northwell Health, New Hyde Park, NY
Background (issue): Open hand fractures may be difficult to recognize and treat. There is variability in management and administration of antibiotics for these types of injuries. Unlike open long bone fractures, there is no standardized protocol for antibiotic administration for open hand fractures in children.
Methods: We performed a retrospective chart review at a tertiary hospital in New York of patients with hand injuries between age 0-18 years presenting to the emergency department (ED) during January 2019 and December 2020. Patient encounters were reviewed for open fractures of the hand. Descriptive statistics were included for demographic and physical characteristics.
Findings: There were 80 encounters with open hand fractures, of which the most common being tuft fractures (73.7%). The mean age was 7.6 years (SD 4.7) with male predominance (58.8%). Crush injuries were the most common mechanism of injury (78.8%). Bedside repair was performed on 62 (77.5%) encounters, of which 45 (75.6%) required nail bed repair, 56 (90.3%) required suturing and 24 (38.7%) required reduction. Antibiotics were given to 62 (77.5%) encounters, most commonly oral cefalexin (45.2%), oral amoxicillan-clavuanic acid (27.4%), and intravenous cefazolin (14.5%). Median time to antibiotics from ED registration to administration was 150 minutes (IQR 92-216). Antibiotic prescriptions were sent for 71 encounters (78.8%). Seventy-seven (96.3%) of the encounters were discharged home.
Conclusions (implications for practice): Pediatric open hand fractures have a variability of type and timing to antibiotics. Future initiatives should attempt to create standardized guidelines for management of open hand fractures.
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