Article Figures & Data
Figures
- Figure 1
Heat map identifying locations of initial hospitals transfer patients with femur fractures to Saint Mary’s Medical Center (black star). Hospitals located in rural localities are in light gray, and urban/suburban hospitals are in black. The size of the circles corresponds to the relative number of patients transferred. The coverage area of our trauma system is quite large, spanning three states (Minnesota, Wisconsin, and Michigan) and serves a large rural population.
Tables
- Table 1
Descriptive statistics for all trauma transfers during the study period and the femur fracture subgroup
Demographics All transfers
n=1837Femur fracture subgroup
n=398Sex (female), n (%) 784 (42.7) 247 (61.6) Age, mean (SD) 56.9 (24.6) 71.39 (20.92) Race (Caucasian), n (%) 1681 (91.5) 378 (94.3) ISS, median (IQR) 9 (5–9) 9 (9–9) Rural, n (%) 1391 (74.1) 323 (81.7) Blunt mechanism, n (%) 1749 (92.7) 401 (100) Alcohol involved in trauma, n (%) 304 (16.1) 145 (36.2) In-hospital mortality, n (%) 57 (3.0) 7 (1.8) Patient and injury variables for all patients transferred to our trauma center between May 2016 and April 2019 and the femur fracture subgroup. Femur fracture patients were older, more likely to be female, and had more alcohol use.
IQR, Interquartile range; ISS, Injury Severity Score; n, number of patients.
- Table 2
Patient demographic and injury data for patients with femur fractures, comparing those who underwent fixation within 24 hours of admission to trauma center and those repaired more than 24 hours from admission
Demographics Femur fracture repaired <24 hours Femur fracture repaired >24 hours P value n=296 n=102 Sex (female), n (%) 187 (63) 59 (58) 0.34 Age, median (IQR) 76 (63–85) 78.5 (67–98) 0.1 Race (Caucasian), n (%) 280 (95) 95 (93) 0.84 ISS, median (IQR) 9 (9–9) 9 (9–10) 0.3 Rural, n (%) 238 (81) 85 (83) 0.55 Local hospital ACS trauma designation, n (%) 0.63 Level III 56 (19) 16 (16) Level IV 198 (66) 68 (67) Undesignated 44 (15) 18 (17) Alcohol involved in trauma, n (%) 24 (8) 7 (7) 0.67 Median Elixhauser score (IQR) 0 (0–2) 1 (0–2) 0.11 Elilxhauser Score >2, n (%) 46 (20) 16 (22) 0.71 Transfer time, hours, median (IQR) 4.4 (3.8–5.8) 4.8 (3.8–6.1) 0.28 Initial hospital LOS, hours, median (IQR) 2.8 (2.2–4.0) 3.2 (2.4–5.6) 0.1 Time to fracture repair, hours, median (IQR) 14.5 (8.8–18.0) 40.6 (30.9–49.7) 0.027 Primary admitting service, n (%) 0.009 Orthopedic trauma 247 (77) 74 (23) Trauma surgery 31 (72) 12 (27) Medicine 18 (53) 16 (47) Trauma center LOS, days, median (IQR) 4 (3–6) 5 (5–8) <0.001 ICU admission, n (%) 15 (5) 10 (10) 0.08 ICU LOS, days, median (IQR) 2 (1–4) 4 (2.75–8) 0.08 Discharge disposition, n (%) 0.021 Home 94 (32) 19 (19) Nursing home 165 (56) 76 (75) Acute rehabilitation unit 28 (10) 6 (6) Complication during stay, n (%) 36 (12) 23 (23) 0.01 In-hospital mortality, n (%) 6 (2) 1 (1) 0.49 30-day hospital mortality, n (%) 17 (6) 5 (5) 0.75 ACS, American College of Surgeons; ICU, intensive care unit; ISS, Injury Severity Score; LOS, length of stay; n, number of patients.
- Table 3
Univariate analysis comparing patient variables and complication rates
Demographics No complication Complication P value n=339 n=59 Sex (female), n (%) 212 (63) 34 (58) 0.47 Age, median (IQR) 76 (63–85) 82 (72–89) 0.003 Race (Caucasian), n (%) 322 (95) 53 (90) 0.39 ISS, median (IQR) 9 (9–10) 9 (9–10) 0.83 Rural, n (%) 272 (81) 51 (86) 0.28 Alcohol involved in trauma, n (%) 27 (8) 4 (7) 0.75 Elixhauser score, median (IQR)
Elixhauser Score >2 n (%)0 (0-2)
41 (16)2 (0-4)
24 (41)< 0.001
< 0.001Total transfer time, hours, median (IQR) 4.5 (3.7–5.9) 4.7 (3.8–5.7) 0.8 Time at initial hospital, median (IQR) 2.9 (2.2–4.1) 3.2 (2.4–4.3) 0.38 Time to fracture repair, median (IQR) 16.6 (10.8–23.1) 22.3 (16.0–36.6) 0.03 Hospital LOS, days, median (IQR) 4 (3–6) 7 (6–10) <0.0001 ICU admission, n (%) 8 (2) 17 (29) <0.0001 ICU LOS, days, median (IQR) 3.5 (2.25–7.25) 2 (1–4.5) 0.34 Discharge disposition, n (%) <0.0001 Home 105 (31) 8 (14) Nursing home 202 (60) 39 (66) Acute rehabilitation 30 (9) 4 (7) In-hospital mortality, n (%) 1 (0.3) 6 (10) <0.0001 30-day hospital mortality, n (%) 12 (4) 10 (17) <0.0001 Older age, longer time to fracture repair, and longer hospital stays were all associated with complications. Patients with complications were more likely to need intensive care, had higher mortality rates, and were less likely to be discharged home.
ICU, intensive care unit; ISS, Injury Severity Score; LOS, length of stay; n, number of patients.
- Table 4
Multivariate analysis for risk of complication after femur fracture repair using binary logistic regression
Adjusted OR for complications (95% CI) P value Sex (female) 0.76 (0.39 to 1.49) 0.42 Age (per year increase) 1.04 (1.01 to 1.07) 0.003 Elixhauser score >2 3.45 (1.75 to 6.80) <0.001 Fixation performed >24 hours after trauma center admission 2.08 (1.1 to 4.1) 0.04 Transfer time (per hour increase) 0.94 (0.80 to 1.09) 0.41 When including patients’ age, sex, presence of more than 2 comorbidities on the Elixhauser score, and time to fixation greater than 24 hours, we found that age, comorbidities, and delayed repair of fracture were independent risk factors for complications. Transfer time was not associated with increased risk of complications in this model.
