Time Savings and Safety of EMS Administration of Antibiotics for Open Fractures

Abstract

Introduction

Early administration of antibiotics for open fractures reduces serious bone and soft tissue infections. The effectiveness of antibiotics in reducing these infections is time-dependent, with various surgical associations recommending administration within one hour of injury, or within one hour of patient arrival to the emergency department (ED). The extent to which prehospital antibiotic administration in these situations might reduce the time to treatment has not been previously reported. The purpose of this study was to describe current prehospital use of antibiotics for traumatic injury, to assess the safety of prehospital antibiotic administration, and to estimate the potential time-savings associated with antibiotic administration by EMS clinicians.

Methods

This was a retrospective analysis of the 2019 through 2022 ESO Data Collaborative research data set. Included subjects were patients that had a linked ICD-10 code indicating an open extremity fracture and who received prehospital antibiotics. Time to antibiotic administration was calculated as the elapsed time from EMS dispatch until antibiotic administration. The minimum potential time saved by EMS antibiotic administration was calculated as the elapsed time from administration until ED arrival. To assess safety, epinephrine and diphenhydramine administration were used as proxies for the adverse events of anaphylaxis and minor allergic reactions.

Results

There were 523 patients meeting the inclusion criteria. The median (and interquartile range [IQR]) elapsed time from EMS dispatch until antibiotic administration was 31 (IQR: 24-41) minutes. The median potential time savings associated with prehospital antibiotic administration was 15 (IQR: 8-22) minutes. Notably, 144 (27.5%) of the patients who received prehospital antibiotics had total prehospital times exceeding one hour. None of the patients who received antibiotics also received epinephrine for presumed anaphylaxis.

Conclusions

EMS clinicians were able to safely administer antibiotics to patients with open fractures a median of 15 min before arrival at the hospital, and 99% of the patients receiving antibiotics had them administered within one hour of EMS dispatch. EMS administration of antibiotics may be a safe way to increase compliance with recommendations for early antibiotic administration for open fractures.

Acknowledgments

The study team was assembled as part of the Spring 2023 University of California, Los Angeles, Prehospital Care Research Forum (PCRF) research workshop hosted at ESO Inc. in Austin, Texas. We specifically acknowledge David Page (DP), Scott Bourn (SB), Remle P. Crowe (RPC), Antonio Fernandez (AF), and Brent Myers (BM) for their contributions to the success of the forum. We thank ESO and RPC for the availability and preparation of the data set used for analysis. The content derived from this data set remains the property of ESO Inc. ESO is not responsible for any claims arising from works based on the original data, text, tables, or figures. We acknowledge RPC for providing feedback on the initial study design and the manuscript.

Authors’ Contributions

ADM, DJG, SAS, AMP, CGC, BW, DFK and LHB conceived the research question and designed the study. The literature review was conducted by all authors and finalized by DJG, ADM and LHB. LHB conducted data analysis. All authors reviewed the results and participated in their interpretation. Manuscript sections were drafted by ADM, SAS and LHB; the combined manuscript was edited by ADM, DJG, DFK and LHB. The final manuscript was reviewed and approved by all authors.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Data availability statement

The ESO Data Collaborative data are available upon request to and review by ESO.

Additional information

Funding

The workshop where this study originated was supported by grant funding from the GMR Foundation for Research and Education, but GMR had no role in the design, execution, or reporting of this study.