The acute management of ankle fractures (Augment) study: a prospective trainee led national collaborative audit of the Boast 12 guidelines.
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Authors
Dalwai, Ramesh
Dixit, Anurag
Papachristou, Athanasios
Sharma, Akshat
Thomas, Osmond L
Issue Date
2021-01-05
Journal
Type
Article
Peer-Reviewed Publication
Peer-Reviewed Publication
Keywords
Acute management of ankle fractures
Adult
Ankle
Ankle fracture
Audit
AUGMENT Collaborative
BOAST 12 guidelines
British Orthopaedic Association (BOA)
British Orthopaedic Foot and Ankle Society (BOFAS)
Clinical effectiveness
Compliance
Discharge
Fracture fixation
Guideline
Internal fracture fixation
Lower extremity
Management
Multicentre study
Orthopaedic procedures
Outcomes
Peer-reviewed article
Prospective study
Surgery
Trainee led
Treatment
Adult
Ankle
Ankle fracture
Audit
AUGMENT Collaborative
BOAST 12 guidelines
British Orthopaedic Association (BOA)
British Orthopaedic Foot and Ankle Society (BOFAS)
Clinical effectiveness
Compliance
Discharge
Fracture fixation
Guideline
Internal fracture fixation
Lower extremity
Management
Multicentre study
Orthopaedic procedures
Outcomes
Peer-reviewed article
Prospective study
Surgery
Trainee led
Treatment
Journal Title
The Surgeon
Volume
Issue
Begin page
End page
Abstract
Background: Ankle fractures are one of the most common fractures in adults aged 20-65 years. The British Orthopaedic Association (BOA) and British Orthopaedic Foot and Ankle Society (BOFAS) jointly produced Standards for Trauma (BOAST) BOAST 12, with the aim of reducing morbidity by standardising care of these injuries. The primary aim of the AUGMENT study was to determine the extent and clinical effect of variation from BOAST 12.
Methods: AUGMENT was a multi-centre prospective trainee led audit of consecutive patients presenting with an ankle fracture within a four-week period. Data were collected on patient demographics, comorbidities, management and 12-week outcome. The BOAST 12 standards were divided into four subgroups; documentation, imaging, management and follow-up. Percentage compliance with each subgroup was analysed. A multivariate logistic regression analysis was used to determine impact of overall compliance on likelihood of discharge in follow-up period.
Findings: 971 patients were included across 52 sites. The overall rate of BOAST 12 compliance was 41.7%. Variations in practice were observed in clinical documentation, especially of neurovascular status, (40.7%) and VTE assessment (61.5%). Patient management compliance with all 16 of the BOAST 12 standards was associated with a higher rate of discharge during the 12-week follow-up period (p = 0.005).
Conclusion: AUGMENT has demonstrated that the management of ankle fractures is variable across the UK. Over half of patients had aspects of their care that were not BOAST 12 compliant. When compliance was observed, it was associated with earlier discharge from orthopaedic care.
Citation
Fennelly JT, Gourbault LJ, Stedman T, Price MJ, Ward AE; AUGMENT Collaborative. The acute management of ankle fractures (Augment) study: A prospective trainee led national collaborative audit of the Boast 12 guidelines. Surgeon. 2021 Jan 4:S1479-666X(20)30174-8. doi: 10.1016/j.surge.2020.11.001. Epub ahead of print. PMID: 33414043.