AI Article Synopsis

  • The study evaluated an open fracture intervention bundle's effect on adults in Malawi with tibia fractures, focusing on clinical management and patient outcomes.
  • Researchers analyzed data from 287 patients before and after implementing educational courses and management guidelines, measuring changes in patient function and clinician knowledge.
  • While clinician knowledge improved post-intervention, there were no significant enhancements in clinical management practices, and evidence suggested a decline in patient function one year after the injury.

Article Abstract

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 in clinician knowledge and positive evaluation of the intervention implementation, our study showed that there was no overall improvement in clinical management, and weak evidence of worsening patient function 1 year after injury, after implementation of the open fracture intervention bundle.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10976873PMC
http://dx.doi.org/10.2471/BLT.23.290755DOI Listing

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