Do Trauma Patients With Diabetes Face Higher Complication Rates?

By Brian McCurdy, Senior Editor

Patients with diabetes face a higher risk of complications in a number of areas. A large study recently published in the Archives of Surgery notes that those with diabetes also face more complications from trauma surgery.

From 1984 to 2002, researchers examined 12,489 patients with diabetes, matching their ages, sex and injury severity with 12,489 non-diabetic patients from 27 Pennsylvania trauma centers. The study concluded that patients with diabetes spent more time in the intensive care unit and received ventilator support for a longer period of time. Twenty-three percent of patients with diabetes had complications in comparison to 14 percent of those without diabetes. The study did not note a difference in mortality rates or the length of hospital stay.

Eric Espensen, DPM, has likewise seen a higher rate of complications in trauma patients with diabetes. He says the complications have usually involved a higher rate of infection, even in the face of empirically prescribed antibiotics. Dr. Espensen, the Chief of Foot Surgery at Providence St. Joseph Medical Center in Burbank, Calif., also notes an increased rate of wound dehiscence and slower rates of healing in trauma patients with diabetes.

In his clinical experience, Dr. Espensen notes that the length of hospital stay for trauma patients with diabetes tends to be longer than the hospital stay of trauma patients without diabetes.

Striving Toward Fewer Complications
What measures can hospitals take to reduce the risk of complications for trauma patients with diabetes? Dr. Espensen notes that his facility has “become much more aggressive” in the selection of antibiotics for trauma patients with diabetes. He says this includes empiric coverage for both gram positive and gram negative bacteria. His hospital has implemented stricter guidelines for managing glucose, including various tiers of sliding scales. Dr. Espensen adds that his hospital is “much more likely” to perform lower extremity non-invasive vascular studies on trauma patients with diabetes and call for vascular consults at a higher rate with this patient population.

What factors are contributing to higher complication rates in trauma patients with diabetes? Generally, Dr. Espensen says the phenomenon is due to poor management of glucose as well as various stages of progression of diabetes and generally advanced stages of peripheral vascular disease in patients with the disease.

He notes that the aforementioned contributory factors are the same for those with diabetic foot ulcers or patients with diabetes who are undergoing elective surgery. Accordingly, whether a patient with diabetes has trauma or not, Dr. Espensen says physicians should have “the same heightened level of awareness of possible complications.

“My group has taken the approach to apply these ‘higher standards of care’ to all patients, regardless of the presence of diabetes so as to provide the highest level of care to all patients,” emphasizes Dr. Espensen. “This has decreased our complication rate for all patients, diabetic or not.”

Is Hyaluronic Acid Effective For Pain From Ankle Sprains?
By Brian McCurdy, Senior Editor

Can hyaluronic acid be helpful in treating ankle sprains? A recent study in the Clinical Journal of Sport Medicine found that this modality can reduce pain in athletes with sprains and help get them back to sports earlier.

The randomized study involved 158 competitive athletes, who had sustained acute grade 1 or 2 lateral ankle sprains and were treated within 48 hours after their injuries. The study notes that about 30 percent of ankle sprains were the first sprains suffered by participants.

The treatment group received periarticular injection with hyaluronic acid and the standard of care while the control group received a placebo injection and standard of care. Researchers provided treatment at the initial visit and four days after the injury, according to the study. Researchers assessed patients on days four, eight, 30 and 90 following injury.

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