American Academy of Orthopaedic Surgeons Appropriate Use Criteria: Prevention of Surgical Site Infections After Major Extremity Trauma

The Major Extremity Trauma and Rehabilitation Consortium and the American Academy of Orthopaedic Surgeons have developed Appropriate Use Criteria for the Prevention of Surgical Site Infections (SSIs) After Major Extremity Trauma. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to determine appropriateness of various treatments for the prevention of SSIs after major extremity trauma. Scenarios were derived by identifying clinical indications typical of patients suspected of developing an SSI in clinical practice. Indications are most often parameters observable by the clinician, including symptoms or results of diagnostic tests. A total of 588 patient scenarios and 14 treatments were developed by the writing panel, a group of clinicians who are specialists in this Appropriate Use Criteria topic. Next, a separate, multidisciplinary voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as “appropriate” (median rating, 7 to 9), “may be appropriate” (median rating, 4 to 6), or “rarely appropriate” (median rating, 1 to 3).