Brown Timothy S, Hinojosa Lauren S, Cline Kelly E, Black Sheena R, Jamieson Marissa D, Starr Adam J
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
J Orthop Trauma. 2016 Apr;30(4):e129-31. doi: 10.1097/BOT.0000000000000487.
To describe the epidemiology of acute hand injuries and hand infections and to describe the factors associated with the transfer of these patients to a level 1 trauma center. In addition, we sought to understand management before transfer.
Retrospective review of patients with hand trauma or hand infection transferred to our level 1 trauma center from May 2009 to August 2011. We also identified hospitals with emergency departments (EDs) in our region and surveyed ED providers in these hospitals with regard to acute hand care.
A level 1 trauma center in the United States.
Four hundred sixty consecutive transfers for acute hand care.
The average patient age was 38. Most were male (84%), uninsured (51%), and from another county (59%). The average distance of transfer was 51 miles, and 80% were transferred by ground ambulance. The most common reasons for transfer were amputations (24%), infections (21%), lacerations (17%), and fractures/dislocations (16%). Of the 345 hospitals with an ED surveyed, 71% never had hand surgery coverage.
Patients transferred for acute hand care were young and male, and traveled an average 51 miles to get to our center. More than half of these patients were treated and discharged from our ED. This indicates that a majority may have been managed in a clinic setting. Most EDs in our region do not have a hand surgeon available. Most emergency physicians surveyed had received little training in management of acute hand injuries and hand infections. Further research is needed to identify methods to remove barriers to provision of care for patients with hand trauma.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
描述急性手部损伤和手部感染的流行病学特征，并描述这些患者转至一级创伤中心的相关因素。此外，我们试图了解转运前的处理情况。
对2009年5月至2011年8月转至我们一级创伤中心的手部创伤或手部感染患者进行回顾性研究。我们还确定了本地区设有急诊科（ED）的医院，并就急性手部护理情况对这些医院的急诊科医护人员进行了调查。
美国一家一级创伤中心。
连续460例因急性手部护理而转诊的患者。
患者平均年龄为38岁。大多数为男性（84%），未参保（51%），且来自其他县（59%）。平均转运距离为51英里，80%通过地面救护车转运。最常见的转运原因是截肢（24%）、感染（21%）、撕裂伤（17%）和骨折/脱位（16%）。在接受调查的345家设有急诊科的医院中，71%从未有过手外科覆盖。
因急性手部护理而转诊的患者年轻且多为男性，平均要行驶51英里才能到达我们的中心。这些患者中有一半以上在我们的急诊科接受治疗并出院。这表明大多数患者可能在诊所环境中接受了治疗。我们地区的大多数急诊科没有手外科医生。接受调查的大多数急诊医生在急性手部损伤和手部感染的处理方面接受的培训很少。需要进一步研究以确定消除手部创伤患者获得护理障碍的方法。
预后水平IV。有关证据水平的完整描述，请参阅作者指南。
