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Patients Transferred to a Regional Medical Center for Emergent Hand and Upper Extremity Problems
Eric Wenzinger, BS; Angel Rivera-Barrios, MD; Robinder Singh, MD; Fernando Herrera, MD
Medical University of South Carolina, Charleston, SC

Introduction: Hand and upper extremity injuries are one of the leading causes of injury in the United states, making up to 10% of all emergency room visits. The complex nature of these injuries can often exceed the services available in rural and less populated areas, requiring the service of a fellowship trained upper extremity specialist. The purpose of this study is to identify the demographics, specific injuires, and reason for transfer of patients referred to a regional level one trauma center.
Methods: A retrospective review of our Hand trauma database was performed over a three year period from July 2011 to June of 2014. All patients accepted as transfers from another institution were identified. Demographic data were collected to include, gender, age, race, insurance status, injury type, mechanism, need for emergent surgery, reason for transfer. Descriptive statistics were calculated including means and standard deviations for continuous variables and frequencies for categorical variables.
Results: Patients transferred from outside institutions to MUSC are more likely to be uninsured or poorly insured, totaling 67.8%. Ninety five percent of patients were transferred from a level II hospital or higher. The most frequent reason for transferring was higher level of care needed or no hand specialist available. The average age was 38 years of age, 77% were male. Seventy percent of patients were white, 24% african american, 5 % hispanic. Patients were no more likely to be transferred on weekends than on week days. However, 61% of all transfer patients accepted to MUSC were transferred outside of normal hours of operation. Furthermore, 58.1% of the patients transferred outside of normal hours of operation required subsequent surgical correction by a hand or upper extremity specialist.
Conclusion: Hand injuries result in frequent emergency room visits. Many hospitals are lacking in hand specialist coverage and require transfer to regional medical centers for coverage. These patients tend to be male, younger and poorly insured.

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