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Characterizing isolated hand trauma transfers to Level 1 trauma center in Southeast USA
Hiba Saifuddin, MD
1; Meredyth Berard, BS
1; Alexandra Bartholomew, BS
1; Andrew J Malek, BS
2; Daniel Yoo, MD
1; Sharon Stanley, MD
31Louisiana State University, New Orleans, LA; 2Louisiana State University Health Sciences Center, New Orleans, LA; 3University of Arizona College of Medicine - Tuscon, Tuscon, AZ
Introduction
Level 1 trauma centers receive hand surgery transfers from a wide catchment area
including hospitals from hundreds of miles away. Previous studies indicate there is a
proportion of transfers that do not necessitate higher level of care. The purpose of our
study is to characterize the hand transfers to our level 1 trauma center in the Southeast
Region and identify the proportion of patients who require emergent evaluation and
treatment by a hand surgeon.
Materials & Methods
The trauma database was queried for patients transferred for isolated hand and wrist
injuries between June 2018 and June 2023. Exclusion criteria included polytrauma and
medical comorbidities necessitating transfer. A retrospective chart review was
performed to collect patient demographics, insurance carrier, level of transferring
facility and referring provider, time of transfer, mechanism of injury, and management of
injury. Descriptive statistics were performed on the data points.
Results
A total of 241 patients were identified. 78.4% were transferred from non-trauma
designated hospitals. Two patients from Level 1 trauma centers were transferred for
evaluation for revascularization/replantation. The most common insurer was
Medicaid (39.8%). 51.9% of transferred patients were admitted and underwent surgery
during the hospitalization. 40.2% of patients suffered sharp/penetrating trauma.
Complete digit amputation was for the most common reason for transfer. Average
distance travelled for transfer was 64.4 miles (range: 0.4-325).
Conclusions
Slightly more than half of isolated hand/wrist transfers to our level 1 trauma center in the
Southeast Region required admission and surgical intervention. Education of
emergency room providers should be undertaken to temporize hand injuries that do not
require urgent evaluation and treatment by a hand surgeon and to prevent the
unnecessary costs and time associated with inter-facility transfer. Patients are
responsible for their return trip home, which can pose a large financial and social
burden. Our findings may not be applicable to regions that are highly saturated with
surgical subspecialties.
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