Amis Benjamin, Friedrich Jeffrey
Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Box 359798, 325 Ninth Ave., Seattle, WA 98104 USA.
Hand (N Y). 2012 Sep;7(3):259-62. doi: 10.1007/s11552-012-9431-3.
The purpose of this paper is to compare a group of patients with upper extremity amputation injuries who presented to a tertiary referral center without having been previously seen at another hospital versus a group of patients who was transferred from another facility. We hypothesize that transferred patients will generally undergo more complex treatments, that some transferred patients will be treated in the ER with simple treatments (thereby perhaps not requiring transfer), and that transferred patients will be less likely to have insurance coverage.
All patients who presented to our ER from January 1, 2007 to December 31, 2008 with the classification of hand and finger amputation were included. Data collected included whether or not the patient was transferred from another institution, age, mechanism of injury, partial versus total amputation, location treated, transportation method, general treatment classification, type of insurance, and month of presentation.
No statistical difference was found between patients who were transferred versus those who were not with respect to age, sex, mechanism, whether the amputation was partial versus complete, or insurance coverage. Statistical differences were noted between the subset of patients who was transferred versus those who were not with respect to treatment location, method of transportation, and treatment.
Patients transferred to our institution required significantly more complex treatments and were significantly more likely to be treated in the operating room. A small but significant group of patients was treated in the ER or required relatively simple treatments after transfer. Our hypothesis that a higher percentage of patients transferred to our institution would have less insurance coverage was not supported by the data. Tertiary centers can expect to continue receiving a steady stream of amputation referrals.
本文旨在比较一组上肢截肢伤患者，这组患者前往三级转诊中心就诊，此前未在其他医院就诊，与另一组从其他机构转来的患者。我们假设，转来的患者通常会接受更复杂的治疗，一些转来的患者会在急诊室接受简单治疗（因此可能不需要转院），并且转来的患者获得保险覆盖的可能性较小。
纳入2007年1月1日至2008年12月31日期间到我院急诊室就诊且分类为手和手指截肢的所有患者。收集的数据包括患者是否从其他机构转来、年龄、损伤机制、部分截肢与完全截肢、治疗地点、运输方式、一般治疗分类、保险类型以及就诊月份。
在转来的患者与未转来的患者之间，在年龄、性别、损伤机制、截肢是部分还是完全、或保险覆盖方面未发现统计学差异。在转来的患者子集与未转来的患者子集之间，在治疗地点、运输方式和治疗方面存在统计学差异。
转至我院的患者需要明显更复杂的治疗，并且在手术室接受治疗的可能性明显更高。一小部分但数量可观的患者在急诊室接受治疗或转院后需要相对简单的治疗。我们关于转至我院的患者中更高比例的患者保险覆盖较少的假设未得到数据支持。三级中心有望继续收到稳定的截肢转诊病例。
