St Mary's Hospital, the major trauma centre for West London, treated 168 patients with lower limb open fractures in 2011 & 2012. This audit compared antibiotic administration in the emergency department against the current BOAST IV guidelines.

The choice, timing, dose, and documentation of antibiotic administration was collected from the casualty cards and the transfer documentation for any patient initially seen at another hospital. The severity of the injury (as the Gusitollo-Anderson classification) after the initial debridement and any infectious complications that presented before discharge were also recorded.

The results showed a higher compliance with the BOAST IV guidelines for those patients directly admitted rather than transferred to the major trauma centre. In direct admissions the recommended antibiotics were either not given or not adequately documented in 7% of cases. In those patients transferred from another emergency department the documentation was inadequate in 27% of cases.

The likely causes of these results are discussed alongside the unit's bone infection rates.