Outcome of delayed presentations of open traumatic hand infections: a prospective cohort study

Objective: To evaluate the outcomes of delayed presentation in patients with open hand infections managed at Civil Hospital Karachi (CHK), with a focus on hospital stay, surgical interventions, and operative duration, to inform clinical decision-making and policy planning. Methods: A prospective observational study was conducted at the Plastic Surgery Department, CHK, Pakistan from January to June 2022. Ethical approval was obtained from the Institutional Review Board of Dow University of Health Sciences (IRB-2354/DUHS/Approval/2021/708). A total of 188 patients aged 18–65 years with clinically confirmed hand infections were enrolled. Patients were stratified into delayed (>24 hours) and non-delayed (≤24 hours) presentation groups. Exclusion criteria included burn injuries, postoperative infections, and chronic inflammatory disorders. Data were collected on demographics, clinical presentations, comorbidities, severity of infection, microbiology, surgical intervention, and outcomes. Statistical analysis was performed using SPSS version 24, with significance set at p≤0.05. Results: Of 188 patients, 94 (50%) had delayed presentation. The mean age was 39.56±12.05 years; 88.8% were male. Pseudomonas aeruginosa (59%) and MRSA (35.6%) were the most common organisms. Mild, moderate, and severe infections were noted in 35.6%, 36.7%, and 27.7% of patients, respectively. Debridement was the most common surgery (76.6%). Delayed presentation was significantly associated with longer hospital stay (10.44±2.45 vs. 4.29±0.65 hours), more frequent surgeries (2.32±0.49 vs. 1.01±0.01), and longer operative time (1.57±0.56 vs. 0.47±0.09 hours) (p<0.001 for all). Conclusion: Delayed presentation in open hand infections is significantly associated with worse clinical outcomes. Early recognition and timely intervention are essential to reduce morbidity and healthcare burden.