Table I.
Descriptive characteristics of patients with severe open tibial fractures treated in England during 2008 to 2019, as recorded by the Trauma Audit and Research Network.
| Whole study period | Whole study period 2012 to 2019 |
2012 to 2015 | 2016 to 2019 | ||||
|---|---|---|---|---|---|---|---|
| Variable | Total | Treated at a MTC | Treated at another hospital | Treated at a MTC | Treated at another hospital | Treated at a MTC | Treated at another hospital |
| Total patients, n (%) | 8,258 (100) | 4,867 (100) | 3,391 (100) | 2,252 (100) | 2,015 (100) | 2,615 (100) | 1,376 (100) |
| Sex, n (%) | |||||||
| Male | 5,219 (63) | 3,325 (68) | 1,849 (56) | 1,540 (68) | 1,176 (58) | 1,785 (68) | 718 (52) |
| Female | 3,039 (37) | 1,542 (32) | 1,497 (44) | 712 (32) | 839 (42) | 830 (32) | 658 (48) |
| Age, yrs, n (%) | |||||||
| 0 to 9 | 178 (2) | 119 (2) | 59 (2) | 78 (3) | 37 (2) | 41 (2) | 22 (2) |
| 10 to 19 | 674 (8) | 419 (9) | 255 (8) | 211 (9) | 170 (8) | 208 (8) | 85 (6) |
| 20 to 29 | 1,308 (16) | 854 (18) | 454 (13) | 379 (17) | 290 (14) | 475 (18) | 164 (12) |
| 30 to 39 | 1,080 (13) | 701 (14) | 379 (11) | 308 (14) | 231 (11) | 393 (15) | 148 (11) |
| 40 to 49 | 1,133 (14) | 692 (14) | 441 (13) | 371 (16) | 283 (14) | 321 (12) | 158 (11) |
| 50 to 59 | 1,154 (14) | 666 (14) | 488 (14) | 283 (13) | 276 (14) | 383 (15) | 212 (15) |
| 60 to 69 | 920 (11) | 505 (10) | 415 (12) | 236 (10) | 244 (12) | 269 (10) | 171 (12) |
| 70 to 79 | 774 (9) | 403 (8) | 371 (11) | 159 (7) | 192 (10) | 244 (9) | 179 (13) |
| 80 to 89 | 707 (9) | 343 (7) | 364 (11) | 149 (7) | 202 (10) | 194 (7) | 162 (12) |
| 90 and over | 330 (4) | 165 (3) | 165 (5) | 78 (3) | 90 (4) | 87 (3) | 75 (5) |
| Year of arrival at hospital, n (%) | |||||||
| 2012 | 1,538 (19) | 663 (14) | 875 (26) | 663 (29) | 875 (43) | N/A | N/A |
| 2013 | 1,031 (12) | 553 (11) | 478 (14) | 553 (25) | 478 (24) | N/A | N/A |
| 2014 | 830 (10) | 506 (10) | 324 (10) | 506 (22) | 324 (16) | N/A | N/A |
| 2015 | 868 (11) | 530 (11) | 338 (10) | 530 (24) | 338 (17) | N/A | N/A |
| 2016 | 809 (10) | 541 (11) | 268 (8) | N/A | N/A | 541 (21) | 268 (19) |
| 2017 | 1,032 (12) | 670 (14) | 362 (11) | N/A | N/A | 670 (26) | 362 (26) |
| 2018 | 1,131 (14) | 743 (15) | 388 (11) | N/A | N/A | 743 (28) | 388 (28) |
| 2019 | 1,019 (12) | 661 (14) | 358 (11) | N/A | N/A | 661 (25) | 358 (26) |
| Transfer type, n (%) | |||||||
| No transfer | 5,547 (67) | 3,479 (71) | 2,068 (61) | 1,592 (71) | 1,359 (67) | 1,887 (72) | 709 (52) |
| Transfer in | 698 (8) | 557 (11) | 141 (4) | 288 (13) | 92 (5) | 269 (10) | 49 (4) |
| Transfer in and out | 141 (2) | 118 (2) | 23 (1) | 64 (3) | 13 (1) | 54 (2) | 10 (1) |
| Transfer out | 1,872 (23) | 713 (15) | 1,159 (34) | 308 (14) | 551 (27) | 405 (15) | 608 (44) |
| Day and time of presentation at hospital, n (%) | |||||||
| Monday 00:00 to 07:59 | 154 (2) | 99 (2) | 55 (2) | 40 (2) | 29 (1) | 59 (2) | 26 (2) |
| Monday 08:00 to 15:59 | 444 (5) | 231 (5) | 213 (6) | 102 (5) | 124 (6) | 129 (5) | 89 (6) |
| Monday 16:00 to 23:59 | 510 (6) | 314 (6) | 196 (6) | 142 (6) | 107 (5) | 172 (7) | 89 (6) |
| Tuesday 00:00 to 07:59 | 157 (2) | 90 (2) | 67 (2) | 32 (1) | 33 (2) | 58 (2) | 34 (2) |
| Tuesday 08:00 to 15:59 | 459 (6) | 254 (5) | 205 (6) | 115 (5) | 122 (6) | 139 (5) | 83 (6) |
| Tuesday 16:00 to 23:59 | 515 (6) | 312 (6) | 203 (6) | 154 (7) | 123 (6) | 158 (6) | 80 (6) |
| Wednesday 00:00 to 07:59 | 128 (2) | 73 (1) | 55 (2) | 32 (1) | 35 (2) | 41 (2) | 20 (1) |
| Wednesday 08:00 to 15:59 | 438 (5) | 278 (6) | 160 (5) | 120 (5) | 101 (5) | 158 (6) | 59(4) |
| Wednesday 16:00 to 23:59 | 506 (6) | 312 (6) | 194 (6) | 147 (7) | 106 (5) | 165 (6) | 88 (6) |
| Thursday 00:00 to 07:59 | 168 (2) | 95 (2) | 73 (2) | 43 (2) | 38 (2) | 52 (2) | 35 (3) |
| Thursday 08:00 to 15:59 | 487 (6) | 296 (6) | 191 (6) | 143 (6) | 114 (6) | 153 (6) | 77 (6) |
| Thursday 16:00 to 23:59 | 520 (6) | 317 (7) | 203 (6) | 144 (6) | 121 (6) | 173 (7) | 82 (6) |
| Friday 00:00 to 07:59 | 162 (2) | 109 (2) | 53 (2) | 51 (2) | 25 (1) | 58 (2) | 28 (2) |
| Friday 08:00 to 15:59 | 442 (5) | 264 (5) | 178 (5) | 122 (5) | 106 (5) | 142 (5) | 72 (5) |
| Friday 16:00 to 23:59 | 574 (7) | 355 (7) | 219 (6) | 169 (8) | 138 (7) | 186 (7) | 81 (6) |
| Saturday 00:00 to 07:59 | 292 (4) | 180 (4) | 112 (3) | 79 (4) | 65 (3) | 101 (4) | 47 (3) |
| Saturday 08:00 to 15:59 | 433 (5) | 232 (5) | 201 (6) | 111 (5) | 131 (7) | 121 (5) | 70 (5) |
| Saturday 16:00 to 23:59 | 563 (7) | 311 (6) | 252 (7) | 140 (6) | 146 (7) | 171 (7) | 106 (8) |
| Sunday 00:00 to 07:59 | 293 (4) | 163 (3) | 130 (4) | 74 (3) | 78 (4) | 89 (3) | 52 (4) |
| Sunday 08:00 to 15:59 | 419 (5) | 236 (5) | 183 (5) | 125 (6) | 116 (6) | 111 (4) | 67 (5) |
| Sunday 16:00 to 23:59 | 496 (6) | 313 (6) | 183 (5) | 140 (6) | 107 (5) | 173 (7) | 76 (6) |
| Missing | 98 (1) | 33 (1) | 65 (2) | 27 (1) | 50 (2) | 6 (< 1) | 15 (1) |
| Most severely injured body region, n (%) | |||||||
| Abdomen | 19 (< 1) | 14 (< 1) | 5 (< 1) | 4 (< 1) | 2 (< 1) | 10 (< 1) | 3 (< 1) |
| Chest | 238 (3) | 181 (4) | 57 (2) | 83 (4) | 37 (2) | 98 (4) | 20 (1) |
| Head | 300 (4) | 261 (5) | 39 (1) | 127 (6) | 21 (1) | 134 (5) | 18 (1) |
| Limbs | 6,997 (85) | 3,840 (79) | 3,157 (93) | 1,767 (78) | 1,871 (93) | 2,073 (79) | 1,286 (93) |
| Multiple | 683 (8) | 555 (11) | 128 (4) | 265 (12) | 80 (4) | 290 (11) | 48 (3) |
| Other | 5 (< 1) | 4 (< 1) | 1 (< 1) | 2 (< 1) | 0 (0) | 2 (< 1) | 1 (< 1) |
| Spine | 16 (< 1) | 12 (< 1) | 4 (< 1) | 4 (< 1) | 4 (< 1) | 8 (< 1) | 0 (0) |
| AIS Limb, n (%) | |||||||
| 3 | 8,249 (99) | 4,858 (99) | 3,391 (100) | 2,247 (99) | 2,015 (100) | 2,611 (99) | 1,376 (100) |
| 4 | 9 (< 1) | 9 (< 1) | 0 (0) | 5 (< 1) | 0 (0) | 4 (< 1) | 0 (0) |
| ISS (continuous) | Median 9 (IQR 9 to 10); Mean 13.15 (SD 9.77) | Median 9 (IQR 9 to 10); Mean 14.75 (SD 11.21) | Median 9 (IQR 9 to 9); Mean 10.86 (SD 6.56) | Median 9 (IQR 9 to 17); Mean 14.75 (SD 10.89) | Median 9 (IQR 9 to 9); Mean 10.96 (SD 6.83) | Median 9 (IQR 9 to 14); Mean 14.75 (SD 11.49) | Median 9 (IQR 9 to 9); Mean 10.71 (SD 6.15) |
| ISS (categorical), n (%) | |||||||
| 1 to 8 (minor) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
| 9 to 15 (moderate) | 6,749 (82) | 3,644 (75) | 3,105 (92) | 1,669 (74) | 1,840 (91) | 1,975 (76) | 1,265 (92) |
| 16 to 24 (severe) | 557 (7) | 441 (9) | 116 (3) | 210 (9) | 72 (4) | 231 (9) | 44 (3) |
| > 24 (very severe) | 952 (12) | 782 (16) | 170 (5) | 373 (17) | 103 (5) | 409 (16) | 67 (5) |
| Injury type, n (%) | |||||||
| Blunt | 7,998 (97) | 4,767 (98) | 3,231 (95) | 2,201 (98) | 1,893 (94) | 2,566 (98) | 1,338 (97) |
| Penetrating | 260 (3) | 100 (2) | 160 (5) | 51 (2) | 122 (6) | 49 (2) | 38 (3) |
| Injury mechanism, (%) | |||||||
| Vehicle incident/collision | 3,974 (48) | 2,783 (57) | 1,191 (35) | 1,308 (58) | 752 (37) | 1,475 (56) | 439 (32) |
| Fall less than 2 m | 2,779 (34) | 1,210 (25) | 1,569 (46) | 532 (24) | 857 (43) | 678 (26) | 712 (52) |
| Fall more than 2 m | 771 (9) | 469 (10) | 302 (9) | 218 (10) | 193 (10) | 251 (10) | 109 (8) |
| Other | 734 (9) | 405 (8) | 329 (10) | 194 (9) | 213 (11) | 211 (8) | 116 (8) |
| Pre-existing condition?, n (%) | |||||||
| Yes | 4,126 (50) | 2,272 (47) | 1,854 (55) | 1,326 (59) | 1,019 (51) | 1,346 (51) | 858 (62) |
| No | 4,132 (50) | 2,595 (53) | 1,537 (45) | 926 (41) | 996 (49) | 1,269 (49) | 518 (38) |
| Pre-existing conditions, n (%) | |||||||
| Hypertension | 1,400 (17) | 694 (14) | 706 (21) | 267 (12) | 368 (18) | 427 (16) | 338 (25) |
| Asthma | 611 (7) | 324 (7) | 287 (8) | 151 (7) | 166 (8) | 173 (7) | 121 (9) |
| Depression | 565 (7) | 301 (6) | 264 (8) | 106 (5) | 129 (6) | 195 (7) | 135 (10) |
| Diabetes mellitus (type 2) | 465 (6) | 238 (5) | 227 (7) | 79 (4) | 93 (5) | 159 (6) | 134 (10) |
| Alcohol abuse | 436 (5) | 231 (5) | 205 (6) | 96 (4) | 117 (6) | 135 (5) | 88 (6) |
| Other - heart disease | 361 (4) | 186 (4) | 175 (5) | 96 (4) | 84 (4) | 90 (3) | 91 (7) |
| COPD | 340 (4) | 166 (3) | 174 (5) | 61 (3) | 78 (4) | 105 (4) | 96 (7) |
| Thyroid disease | 252 (3) | 121 (2) | 131 (4) | 46 (2) | 70 (3) | 75 (3) | 61 (4) |
| Hypercholesterolaemia | 263 (3) | 135 (3) | 128 (4) | 59 (3) | 69 (3) | 76 (3) | 59 (4) |
| Osteoporosis | 186 (2) | 97 (2) | 89 (3) | 27 (1) | 28 (1) | 70 (3) | 61 (4) |
| Number of operations, n (%) | |||||||
| 1 | 3,161 (38) | 1,513 (31) | 1,648 (49) | 723 (32) | 1,008 (50) | 790 (30) | 640 (47) |
| 2 | 2,145 (26) | 1,566 (32) | 579 (17) | 678 (30) | 439 (22) | 888 (34) | 140 (10) |
| ≥ 3 | 1,897 (23) | 1,624 (33) | 273 (8) | 776 (34) | 202 (10) | 848 (32) | 71 (5) |
| Missing | 1,055 (13) | 164 (3) | 891 (26) | 75 (3) | 366 (18) | 89 (3) | 525 (38) |
COPD, chronic obstructive pulmonary disease; IQR, interquartile range; ISS, Injury Severity Score; SD, standard deviation.