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Burden of Hand Maladies in US Emergency Departments
David Colen, MD; Justin P. Fox, MD, MHS; Ines Lin, MD
University of Pennsylvania, Philadelphia

Introduction: Hand conditions commonly present to the emergency department (ED). Yet despite their frequency, few studies have described the magnitude of hand related conditions in the emergency setting beyond traumatic fractures. Therefore, we conducted this study to describe the burden and quantify the healthcare resource utilization of common hand conditions seen in EDs across the United States.

Methods: Using the National Emergency Department Sample, a nationally representative sample of ED encounters, we identified all ED encounters by patients at least 18 years of age that were associated with a common hand condition in 2009, 2011, and 2012. The primary outcomes were prevalence, etiology, and associated charges for common hand conditions. Significance in trends was tested using regression models. All analyses were weighted to account for complex sampling design and to provide national estimates.

Results: The final sample included 25,671,037 ED encounters associated with a common hand condition generating \,639,394,894 in healthcare charges, of which 74.4% had the hand condition as the primary diagnosis. Open wounds (24.9%) predominated, followed by contusions, fractures, and non-specific joint pain (Figure 1). Trauma was the most common etiology (77.4%) with falls (26.3%) and cuts (19.7%) accounting for over half of the presentations. The majority of presentations were able to be managed in the ED (92.2%). There was a trend toward more frequent ED encounters (5% increase, p <0.001) for common hand conditions and higher healthcare charges (24% increase, <0.001) generated in their care over the study period (Figure 2).

Conclusions: Hand related conditions impose a significant burden on EDs nationwide, consuming substantial healthcare resources. We describe the most common hand conditions of various etiologies presenting to U.S. EDs and quantify the aggregate healthcare cost generated as a result. We show that there is an upward trend in both the number of encounters and costs related to hand conditions.

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