Department of Plastic and Hand Surgery, Inselspital, University Hospital Bern, University of Bern, Switzerland.
Uppsala Akademiska Sjukhuset, Orthopaedic and Hand Surgery Department, Uppsala University Hospital, Uppsala, Sweden.
Swiss Med Wkly. 2022 Mar 29;152:w30134. doi: 10.4414/smw.2022.w30134. eCollection 2022 Mar 28.
This study set out to examine the association between current subspecialty (paediatric and hand surgery) consultation practice for children with hand and finger injuries presenting to a tertiary paediatric emergency department and length of stay in the paediatric emergency department. Also, incidence and injury pattern of hand and finger injuries in this patient group were analysed.
This was a retrospective cross-sectional study, which was undertaken as a clinical audit service. All patients under 17 years presenting to our paediatric emergency department with hand and finger injuries over a 17-month period were included in the analysis. We studied incidence and injury mechanism, current subspecialty referral practice, as well as paediatric emergency department and hospital length of stay.
We identified 929 children for inclusion in the analysis. The most frequent reasons for presentation were hand contusions (25.5%) and fractures (20.8%). Paediatric emergency medicine physicians alone managed 845 patients (90.6%), paediatric surgery referral occurred in 50 (5.4%) and hand surgery consultation in 37 (4.0%) cases. Mean length of stay in the paediatric emergency department was 154 min and significantly longer when subspecialty review occurred. Hospital admission occurred in 87 cases (9.3%).
Involvement of subspecialties in the care of hand and finger injuries was associated with significantly increased length of stay in the paediatric emergency department. We discuss obstacles and enablers for timely patient referral and management. We suggest the implementation of referral guidelines, tailored to the individual emergency department, to reduce unnecessary patient journey delays and to ensure higher quality repair of complex hand injuries by the appropriate surgeon, with better outcomes. Making use of the emergence of multiple surgical subspecialties for targeted treatment of paediatric finger and hand injuries might be desirable.
本研究旨在探讨三级儿科急诊中因手部和手指受伤就诊的儿童目前的亚专科（儿科和手外科）咨询实践与儿科急诊停留时间之间的关联。此外，还分析了该患者群体手部和手指损伤的发生率和损伤模式。
这是一项回顾性的横断面研究，作为临床审计服务进行。在 17 个月的时间里，我们分析了所有因手部和手指受伤到我们儿科急诊就诊的 17 岁以下的患者。我们研究了发生率和损伤机制、当前的专科转诊实践，以及儿科急诊和医院停留时间。
我们共纳入 929 名儿童进行分析。就诊的最常见原因是手部挫伤（25.5%）和骨折（20.8%）。儿科急诊医学医师单独管理了 845 名患者（90.6%），儿科外科转诊 50 例（5.4%），手外科咨询 37 例（4.0%）。儿科急诊停留时间的平均值为 154 分钟，当进行专科审查时显著延长。87 例（9.3%）患者住院。
亚专科参与手部和手指损伤的治疗与儿科急诊停留时间显著延长相关。我们讨论了及时转诊和管理的障碍和促进因素。我们建议实施针对个别急诊部门的转诊指南，以减少不必要的患者旅程延误，并确保由合适的外科医生对复杂手部损伤进行更高质量的修复，从而获得更好的结果。利用多个外科亚专科的出现，针对儿童手指和手部损伤进行靶向治疗可能是可取的。
