Improving the management of open tibia fractures, Malawi

作者：Alexander Schade, Maureen Sabawo, Zahra Jaffry, Nohakhelha Nyamulani, Chikumbutso Clara Mpanga, Leonard Banza, Andrew Metcalfe, David G. Lalloo, William J. Harrison, Andrew Leather, Peter MacPherson · 发表于：Bulletin of the World Health Organization · 年份：2024 · DOI：10.2471/blt.23.290755 · 被引用次数：6 · 研究领域：Bone fractures and treatments、Hip and Femur Fractures、Trauma and Emergency Care Studies

Objective: To assess the impact of an open fracture intervention bundle on clinical management and patient outcomes of adults in Malawi with open tibia fractures. Methods: We conducted a before-and-after implementation study in Malawi in 2021 and 2022 to assess the impact of an open fracture intervention bundle, including a national education course for clinical officers and management guidelines for open fractures. We recruited 287 patients with open tibia fractures. The primary outcome was a before-and-after comparison of the self-reported short musculoskeletal function assessment score, a measure of patient function. Secondary outcomes included clinical management; and clinician knowledge and implementation evaluation outcomes of 57 health-care providers attending the course. We also constructed multilevel regression models to investigate associations between clinical knowledge, patient function, and implementation evaluation before and after the intervention. Findings: The median patient function score at 1 year was 6.8 (interquartile range, IQR: 1.5 to 14.5) before intervention and 8.4 (IQR: 3.8 to 23.2) after intervention. Compared with baseline scores, we found clinicians' open fracture knowledge scores improved 1 year after the intervention was implemented (mean posterior difference: 1.6, 95% highest density interval: 0.9 to 2.4). However, we found no difference in most aspects of clinicians' open fracture management practice. Conclusion: Despite possible improvement ...