Updated September 08, 2025
7 min 53 sec estimated read timeOpen long bone fractures are a painful injury. They’re also a race against the clock. Every hour without antibiotics increases the risk of infection and complications. That’s why timely treatment is one of the most important benchmarks in trauma care.
The 2024 ESO Trauma Index takes a closer look at this critical practice, examining:
- How many patients with open long bone fractures received antibiotics
- How quickly antibiotics were given once patients arrived at the trauma center
The 2024 ESO Trauma Index included 975,433 de-identified patient records from 576 participating US hospitals. It offers insights and best practices that trauma systems can use to drive improvement.
Why timing matters
Open fractures are, by definition, contaminated. The clock starts ticking the moment the bone breaks through the skin. Delivering antibiotics early is a proven best practice that reduces infection risk, shortens hospital stays, and improves outcomes. Antibiotics should ideally be given within 60 minutes of arrival at the trauma center, according to the 2024 ESO Trauma Index.
Antibiotics are reaching most patients – but not all equally fast
The Index shows that the majority of patients with open long bone fractures do receive antibiotics, and many are treated within the recommended first hour. In total, about 44,115 patients were diagnosed with an open long bone fracture, and 88% received antibiotics at some point during their care journey. And among all long bone fracture patients, 70% received antibiotics within the golden 60 minutes of arrival at a trauma center.
However, antibiotics weren’t provided evenly across age groups. Similar to previous years, pediatric patients (younger than 18) with open long bone fractures received antibiotics less frequently than adults (18-64). Only 56% of pediatric patients received antibiotics within 60 minutes when excluding prehospital administration; including prehospital data, the figure rises to 67%.
These improvements are encouraging, but significant gaps remain.
EMS plays a critical role
EMS agencies are integral in the time-to-antibiotics equation. We know that antibiotics are most effective the first 60 minutes after injury, but that’s also when many patients are still being transported. When EMS teams administer antibiotics in the field or alert hospitals in advance, patients benefit.
Best practices to close the gap
The 2024 ESO Trauma Index recommends the following actions to improve antibiotic delivery for open long bone fractures:
- Ensure antibiotics are administered within 60 minutes of the patient’s arrival at the trauma center.
- Establish dedicated protocols and working groups focused on antibiotic prophylaxis for open fractures.
- Provide EMS personnel with training to safely administer antibiotics in the field, helping reduce delays and infection risk.
Data drives improvement
Knowing the goals and barriers is insufficient unless we can recommend improvements as well. By using the 2024 ESO Trauma Index to benchmark, trauma centers and hospitals can compare performance and collaborate to make a difference.
We’re moving in the right direction, but not nearly fast enough, especially for children – and particularly when the benefits of antibiotics in open long bone fractures are so well known. Closing these gaps will require increased coordination, faster recognition, and systems designed for speed.
How does your trauma center compare?
Download and read the full 2024 ESO Trauma Index for best practice recommendations.
See the full picture with ESO HDE
Timely antibiotic administration starts with timely data. ESO Health Data Exchange (HDE) helps hospitals and EMS agencies connect prehospital and hospital data for a more complete view of patient care. From scene to ED, ESO HDE ensures critical information flows easily – supporting faster decisions and better outcomes.
