Digital trauma referral and triage under movement restrictions: impact on time-to-surgery and complication risk in Palestine
1
orthopedic surgery, alquds university, hebronp, Palestinian Territory, Occupied
Popul. Med. 2026;8(Supplement Supplement 1):A827
ABSTRACT
BACKGROUND:
In conflict-affected settings, movement restrictions and fragmented referral pathways can delay operative trauma care and increase avoidable complications. Digital consultation and image-supported triage are increasingly used in orthopaedics/trauma and have been associated with feasible, timely clinical decision support.¹,²
METHODS:
We conducted a retrospective before–after cohort study in a tertiary referral hospital in Hebron Governorate, West Bank, Palestine, from January 2022 to December 2024. A structured digital referral pathway was implemented on 1 July 2023 using WhatsApp with a standardized checklist (mechanism, neurovascular status, wound grade, comorbidities), photo/radiograph sharing, and a consultant response target of ≤10 minutes. Eligible patients were limb trauma cases requiring operative management (total N=640; pre-implementation n=315, post-implementation n=325). Primary outcome was time-to-surgery (hours) from first health-facility presentation. Secondary outcomes were 30-day complications (deep infection, unplanned reoperation, compartment syndrome, secondary amputation) and length of stay. Multivariable models adjusted for age, sex, mechanism, open fracture status (Gustilo grade where available), transfer status, diabetes, and an injury-severity proxy.
RESULTS:
Median time-to-surgery decreased from 18.6 hours (interquartile range 10.8–32.9) pre-implementation to 12.4 hours (7.1–22.8) post-implementation (adjusted median difference −5.9 hours). The 30-day complication composite declined from 16.2% to 11.1% (adjusted odds ratio 0.64, 95% CI 0.44–0.94). The largest time gain was observed among inter-facility transfers (adjusted median difference −7.6 hours). These patterns are biologically plausible given established links between delays in definitive care and infection risk in open extremity injuries.³
CONCLUSIONS:
A structured, low-cost digital referral and triage pathway was associated with shorter time-to-surgery and fewer complications in a setting with movement-related access barriers. Integrating standardized digital referral, rapid specialist feedback, and protected operative capacity may advance equity in trauma care and reduce preventable disability.⁴
In conflict-affected settings, movement restrictions and fragmented referral pathways can delay operative trauma care and increase avoidable complications. Digital consultation and image-supported triage are increasingly used in orthopaedics/trauma and have been associated with feasible, timely clinical decision support.¹,²
METHODS:
We conducted a retrospective before–after cohort study in a tertiary referral hospital in Hebron Governorate, West Bank, Palestine, from January 2022 to December 2024. A structured digital referral pathway was implemented on 1 July 2023 using WhatsApp with a standardized checklist (mechanism, neurovascular status, wound grade, comorbidities), photo/radiograph sharing, and a consultant response target of ≤10 minutes. Eligible patients were limb trauma cases requiring operative management (total N=640; pre-implementation n=315, post-implementation n=325). Primary outcome was time-to-surgery (hours) from first health-facility presentation. Secondary outcomes were 30-day complications (deep infection, unplanned reoperation, compartment syndrome, secondary amputation) and length of stay. Multivariable models adjusted for age, sex, mechanism, open fracture status (Gustilo grade where available), transfer status, diabetes, and an injury-severity proxy.
RESULTS:
Median time-to-surgery decreased from 18.6 hours (interquartile range 10.8–32.9) pre-implementation to 12.4 hours (7.1–22.8) post-implementation (adjusted median difference −5.9 hours). The 30-day complication composite declined from 16.2% to 11.1% (adjusted odds ratio 0.64, 95% CI 0.44–0.94). The largest time gain was observed among inter-facility transfers (adjusted median difference −7.6 hours). These patterns are biologically plausible given established links between delays in definitive care and infection risk in open extremity injuries.³
CONCLUSIONS:
A structured, low-cost digital referral and triage pathway was associated with shorter time-to-surgery and fewer complications in a setting with movement-related access barriers. Integrating standardized digital referral, rapid specialist feedback, and protected operative capacity may advance equity in trauma care and reduce preventable disability.⁴
| eISSN: | 2654-1459 |
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