CROSS-MATCH PROTOCOL IN FEMORAL NECK FRACTURES: ONE THAT WORKS

Abstract

Cross match practice for patients with femoral neck fractures continue to cause concern due to a failure of compliance to the existing protocols. We addressed this issue by conducting a number of studies over three years and we report the summation of the studies and demonstrate the reasons for the poor compliance. We provide a simple and effective protocol that has helped reduce preoperative cross matching of femoral neck fractures from 71% to 16.7% two years after its introduction.

Study 1

Retrospective review of the cross-match practice for 240 femoral neck fractures and reviewed the changes in pre-operative and post-operative haemoglobin levels and association with surgical procedure.

Study 2.

Postal questionnaire of 129 anaesthetic and orthopaedic trainees assessing the perceived cross-match requirements of patients with femoral neck fractures based on preoperative haemoglobin values between 8–13g/dl. In addition reviewed the source of trainees perceptions and practice

Study 3

Review of the efficiency of the cross-match protocol two years after its introduction Results

Study 1

71% patients with femoral neck fractures were cross-matched at admission but only 29% of the patients were subsequently transfused. From the 384 units of blood ordered at admission 230 were returned unused. Inter-trochanteric fractures had a mean blood loss of 3.1g/dl (range 1.5–7.2g/dl) following surgery in comparison to a mean loss of 1.7g/dl (0.9–3.4g/dl) for patients with displaced subcapital fractures

Study 2

Orthopaedic trainees at all levels of training requested more blood then their anaesthetic counterparts for patients with femoral neck fractures. There was misconceptions regarding blood loss following surgery amongst all trainees and only 14.3% trainees used existing literature to guide their cross-match practice where as 53.4% devised protocols based on their own or colleagues’ experience.

Study 3

Cross-match protocol was working effectively. Only 16.7% of the patients with femoral neck fractures were cross-matched on admission.

Conclusion

Cross-match recommendations fail to influence trainees. In order to address this we produced a protocol that does not rely on orthopaedic trainees. The haematology MLSO provides the appropriate amount of preoperative blood for the patient based on our finding of blood loss of different fracture patterns and the patients’ preoperative haemoglobin level. Our results show our protocol is still effective two years following its introduction despite numerous changes in trainees during this period.