Antibiotic Prophylaxis in the Management of Distal Fingertip Amputation and Crush Injury

Eliana Schaefer; Jonathan Lawson; Tamara Ibrahim; Gabriel Yohe; Gongliang Zhang; Aviram M Giladi

doi:10.1016/j.jhsg.2023.07.010

Antibiotic Prophylaxis in the Management of Distal Fingertip Amputation and Crush Injury

J Hand Surg Glob Online. 2023 Aug 22;5(6):763-767. doi: 10.1016/j.jhsg.2023.07.010. eCollection 2023 Nov.

Authors

Eliana Schaefer^{1

2}, Jonathan Lawson^{1

2}, Tamara Ibrahim^{1

2}, Gabriel Yohe^{1

3}, Gongliang Zhang^{1

3}, Aviram M Giladi¹

Affiliations

¹ The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
² Georgetown University School of Medicine, Washington, DC.
³ MedStar Health Research Institute, Hyattsville, MD.

Abstract

Purpose: We sought to investigate the role of prophylactic antibiotics for distal fingertip crush injury or transphalangeal amputation treated outside of an operating room and better understand the factors that contribute to antibiotic-prescribing decisions. We hypothesized that prophylactic antibiotics do not meaningfully reduce the incidence of infection and that antibiotics are prescribed in a predictable way.

Methods: This is a retrospective review of all patients treated in a MedStar-affiliated emergency department or urgent care for nonsurgical distal fingertip trauma in 2019. Patient demographics, comorbidities, injury characteristics, interventions, and follow-up details were recorded. Exclusion criteria included signs of infection at the time of presentation, minor injuries not requiring intervention, bite wounds, one-time intravenous antibiotic administration without oral course, and surgical intervention. Outcomes included infection and interventions at follow-up. Chi-square analysis was performed, comparing antibiotic and no-antibiotic groups. A stepwise binomial regression was used to evaluate for variables predictive of antibiotic prescription.

Results: We identified eight infections in 323 patients included in the study (2.5% incidence of infection). There was no statistically significant difference in the incidence of infection between patients treated with antibiotics (2.7%) and those who did not receive antibiotics (2.2%). However, due to the low incidence of infections, we were likely underpowered for this analysis. We also created a model to predict antibiotic prescribing, which achieved an area under the receiver operating characteristic curve of 0.86 (P < .0001) based on age, bleeding disorders, depressive disorders, open wound status, amputation, fractures, and encounter type.

Conclusions: The low incidence of infection (2.5%) and lack of a meaningful difference between the groups call into question prophylactic antibiotic prescribing after these distal fingertip injuries. Our model does predict provider prescribing habits, identifying areas for potential practice pattern change.

Type of study/level of evidence: Therapeutic III.

Keywords: Antibiotic prophylaxis; Crush injuries; Fingertip amputations; Hand trauma; Machine learning.