From the Division of Plastic and Reconstructive Surgery and the Department of Orthopedic Surgery, Massachusetts General Hospital.
Plast Reconstr Surg. 2020 Aug;146(2):332-338. doi: 10.1097/PRS.0000000000006981.
Local health care facilities are often unequipped to treat complex upper extremity injuries, and patients are therefore transferred to designated trauma centers. This study describes the characteristics of patients transferred to a Level I trauma center for hand and upper extremity injuries and to investigate the accuracy of the provided diagnosis at the time of referral.
Adult patients transferred from outside facilities to the authors' Level I trauma center by means of direct contract with the on-call fellow for the care of hand and upper extremity injuries were identified. Patient- and injury-related information was prospectively collected at the time of referral before patient transfer, and again following diagnostic evaluation by a hand surgeon at the authors' institution.
Sixty-three patients were transferred to the authors' hand surgery service from outside facilities after direct contact with the on-call fellow. Most patients were referred by emergency medicine physicians [n = 47 (76 percent)], followed by midlevel emergency department providers (physician assistant or nurse practitioner) [n = 12 (19 percent)] or hand surgeons [n = 3 (5 percent)]. Six patients were transferred directly from a Level I trauma center. Twenty-one transferred patients (33 percent) had an inaccurate diagnosis at the time of referral. Factors associated with an inaccurate diagnosis included trauma level of the referring hospital and diagnoses of infection or dysvascularity.
The diagnostic accuracy for hand injuries transferred from outside facilities by means of provider-to-provider communication is imperfect, and some injuries are misdiagnosed. Hand surgeons should continue to improve the triage and transfer process for patients with acute hand surgery injuries.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.
当地医疗机构通常缺乏治疗复杂上肢损伤的能力，因此患者会被转往指定的创伤中心。本研究描述了转至一级创伤中心治疗手部和上肢损伤的患者特征，并调查了转诊时提供的诊断的准确性。
通过与负责手部和上肢损伤的随叫随到的主治医生直接联系，确定从外部机构转至作者所在的一级创伤中心的成年患者。在患者转院前，于转诊时前瞻性收集患者和损伤相关信息，然后在作者机构的手部外科医生进行诊断评估后再次收集。
63 名患者通过与随叫随到的主治医生直接联系，从外部机构转至作者的手部外科服务。大多数患者是由急诊医师转诊的[47 名（76%）]，其次是中级急诊部提供者（医生助理或执业护士）[12 名（19%）]或手部外科医生[3 名（5%）]。有 6 名患者直接从一级创伤中心转来。21 名转院患者（33%）在转诊时的诊断不准确。与不准确的诊断相关的因素包括转诊医院的创伤级别和感染或血运不良的诊断。
通过提供者对提供者的沟通方式从外部机构转来的手部损伤的诊断准确性并不完美，有些损伤被误诊。手部外科医生应继续改进对急性手部外科损伤患者的分诊和转院流程。
临床问题/证据水平：诊断，IV。
