Peluso Heather A, Parikh Sajni S, Abougergi Marwan S, Walchak Adam C
Division of Plastic and Reconstructive Surgery, Mid-Atlantic Permanente Medical Group, Largo, MD, USA.
Catalyst Medical Consulting, Huntingdon Valley, PA, USA.
J Clin Orthop Trauma. 2025 Feb 11;63:102943. doi: 10.1016/j.jcot.2025.102943. eCollection 2025 Apr.
Hand ailments are frequent reasons for emergency department (ED) visits in the United States. This study analyzed the incidence, causes, outcomes, predictors of hospitalization, and healthcare utilization patterns nationwide.
This retrospective cohort study utilized data from the Nationwide Emergency Department Sample and National Readmission Database from 2016 to 2021. It included patients with a principal diagnosis of hand or wrist complaints.
The study included 29,109,534 ED visits for hand ailments. The mean patient age was 36 years. Most patients were Caucasian (61 %), healthy (89 % Charlson Comorbidity score of 0), male (57 %), and from lower income brackets (60 %). Most injuries were unintentional (71 %), with hand lacerations being the most common reason for presentation, followed by closed distal radius fractures. Most patients were discharged home (96 %). Predictors of admission included older age (adjusted odds ratio (aOR) per decade: 1.03; 95 % Confidence Interval (CI): 1.02-1.03; p < 0.01), higher Charlson index (aOR:1.69; CI:1.65-1.73; p < 0.01), Medicaid insurance or uninsured (aOR:1.26; CI:1.18-1.36, aOR:1.25; CI:1.16-1.36; p < 0.01, respectively), and presentation at level I metropolitan trauma teaching hospitals (aOR:3.48; CI:2.98-4.07; p < 0.01). Admission rates increased by 21 % in 2020 compared to 2016. Healthcare expenditure was a staggering $105 billion in total ED and inpatient hospitalization charges. Expenditure increased significantly, surpassing inflation-adjusted rates.
Our analysis of 29 million patients highlights the healthcare burden posed by hand ailments, with lacerations being the most prevalent concern in emergency settings. Admission and readmission rates were influenced by age, comorbidities, socioeconomic status, insurance type, and hospital characteristics. This study provides a basis for targeted interventions in patient outcome enhancement and resource allocation. Limitations include the reliance on ICD-10-CM coding in the absence of clinical data, which may impact the accuracy of case identification and classification.
手部疾病是美国急诊科就诊的常见原因。本研究分析了全国范围内手部疾病的发病率、病因、结局、住院预测因素及医疗服务利用模式。
这项回顾性队列研究利用了2016年至2021年全国急诊科样本和全国再入院数据库的数据。研究对象为主诊断为手部或腕部疾病的患者。
该研究纳入了29109534例因手部疾病到急诊科就诊的患者。患者平均年龄为36岁。大多数患者为白人（61%）、健康（89%查尔森合并症评分为0）、男性（57%）且来自低收入阶层（60%）。大多数损伤为非故意伤害（71%），手部撕裂伤是最常见的就诊原因，其次是桡骨远端闭合性骨折。大多数患者出院回家（96%）。入院的预测因素包括年龄较大（每增加十岁调整后的优势比（aOR）：1.03；95%置信区间（CI）：1.02 - 1.03；p < 0.01）、查尔森指数较高（aOR：1.69；CI：1.65 - 1.73；p < 0.01）、医疗补助保险或无保险（aOR：1.26；CI：1.18 - 1.36，aOR：1.25；CI：1.16 - 1.36；p < 0.01，分别）以及在一级大都市创伤教学医院就诊（aOR：3.48；CI：2.98 - 4.07；p < 0.01）。与2016年相比，2020年的入院率增加了21%。急诊和住院总费用高达1050亿美元。费用显著增加，超过了经通胀调整后的比率。
我们对2900万患者的分析突出了手部疾病带来的医疗负担，撕裂伤是急诊环境中最普遍的问题。年龄、合并症、社会经济地位、保险类型和医院特征影响入院和再入院率。本研究为有针对性地干预以改善患者结局和资源分配提供了依据。局限性包括在缺乏临床数据的情况下依赖ICD - 10 - CM编码，这可能影响病例识别和分类的准确性。
