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American Association for Hand Surgery

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Hand and Upper Extremity Trauma in Undocumented Immigrants: Higher Incidence of Work-Related and Violence-Related Injuries
Dani C Inglesby, MD1, Jeffrey Okewunmi, BS1, Christine S Williams, MD1 and Eitan Melamed, M.D.2, (1)Icahn School of Medicine at Mount Sinai, New York, NY, (2)NYC Health + Hospitals/Elmhurst, Queens, NY

Introduction
Undocumented immigrants in the United States are exposed to a variety of conditions that put them at high risk for trauma to the upper extremity and poor health outcomes. The purpose of this study was to compare clinical features of upper extremity trauma injuries in documented vs. undocumented patients in a large cohort of patients in New York City's most diverse neighborhood to better characterize clinical features of upper extremity trauma in this population.

Materials & Methods
The hospital trauma database was examined for patients admitted with upper extremity trauma from April 2016 to December 2019. Charts were examined for demographic information, patient documentation status, type and mechanism of injury, the presence of other injuries and comorbidities, length of stay, and mortality rates. Cohorts were compared using paired t tests and chi-squared analysis.

Results
Of the 1,041 patients included, 865 (83.1%) were documented and 176 (16.9%) were undocumented. Undocumented patients were younger (40.5 vs. 62.4 years, p<0.0001), predominantly male (83.5% vs. 57.1%, p<0.0001), and to have fewer comorbidities (42.6% vs. 64.6%, p<0.0001). Undocumented patients were found to have shorter lengths of stay (6.26 vs. 9.1 days, p=0.0040). There was no significant difference in mortality rates between the two populations (3.4% documented vs. 4.0% undocumented, p=0.6932).
Undocumented patients were three times as likely to have been injured at work (13.6% vs. 4.6%, p<0.0001) and nearly twice as likely to having been injured as a victim of violence (19.9% vs. 10.2%, p=0.0003). They were also more likely to have been injured during a bicycle/motorcycle accident (8.0% vs. 3.0%, p= 0.0017) or as a pedestrian struck (21.6% vs. 14.3%, p= 0.0149) and less likely to have been injured by a fall (39.8% vs. 59.3%, p<0.0001) or in an MVC (0.6% vs. 3.5%, p= 0.0402). Injuries that were more common in undocumented patients included phalanx fractures (9.1% vs. 4.4%, p=0.0105), carpal dislocations (1.7% vs. 0.2%, p=0.0070), tendon injuries (2.3% vs. 0.6%, p=0.0284), and lacerations (29.5% vs. 20.1%, p=0.0058).

Conclusion
Undocumented patients presenting with upper extremity trauma represent a younger and healthier cohort of patients with shorter lengths of stay and similar mortality rate to documented residents, but are more likely to be injured at work or as a victim of violence. Documentation status plays a role in the events prior to hospital arrival, and in injury characteristics.


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