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Variation in Admission and Transfer Volume at a Regional Hand Trauma Referral Center
Christopher M. Jones, MD1; Neil Vranis, BS2;, James P. Higgins, MD1; Kenneth R. Means, MD1; Ebrahim Paryavi, MD, MPH1
1Curtis National Hand Center, Baltimore, MD; 2University of Maryland, Baltimore, MD

Hypotheses: A variety of factors may influence the transfer of hand trauma patients to regional hand centers. It is important to understand the factors that contribute to the variation in trauma admission and transfer volume. Our hypotheses were 1) transferred patients constitute a higher proportion of all patient encounters on holidays and weekends, 2) uninsured patients are more likely to be transferred than patients with private insurance, 3) replantation surgery is more likely to be done in transferred patients

Methods: Our institutional hand trauma registry was queried for a record of all encounters spanning a 5 year period between 2009-2014. Descriptive statistics were calculated including means and standard deviations for continuous variables and frequencies for categorical variables. Bivariate relationships between patient origin (primary versus transfer) and demographic covariates were evaluated. Multivariate logistic regression models were used to examine the independent effect of covariates including age, sex, insurance status, injury type, and replantation surgery on patient origin.

Results: The study included 8,260 hand trauma patients evaluated at our institution. Transferred patients accounted for 28.6% of our sample. Weekends and holidays were not associated with increased odds of being transferred (p-values ranged 0.16-0.29). Multivariate logistic regression showed a 93% increased odds of being transferred among patients undergoing replantation (95% CI 23-104%). Penetrating and sharp (slice or saw) injuries had increased odds of 1.58 (95% CI 1.33-1.88) and 1.49 (95% CI 1.32-1.67) for transfer, respectively, when compared to blunt and crush injuries. Additionally, underinsured patients with either medical assistance or self-pay status had an odds ratio of 1.26 (95% CI 1.14-1.39) for transfer. We also observed significantly increased odds of transfer for white patients (OR 1.47, 95% CI 1.33-1.63) compared to all other races, as well as male patients (OR 1.54, 95% CI 1.37-1.74).

Summary:

  • Patients undergoing replantation or revascularization are more likely to be transferred than primarily admitted to a hand trauma center
  • White, male, and underinsured patients are more likely to be transferred
  • Penetrating and sharp hand injuries are more likely to be transferred compared to other injury types
  • There is no difference in relative volume of primary admissions to transfers on weekends and holidays compared to other days of the year
  • Factors that determine whether a patient is transferred to a hand trauma center are not well understood and may include socioeconomic considerations from the referring provider and hospital perspective

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