Hand Trauma Care in the United States

Abstract

BACKGROUND Hand trauma is one of the most complex injuries treated in the emergency department. They are time sensitive and require highly specialized care. Patients may have difficulty accessing appropriate hand trauma care due to a variety of factors. We aimed to evaluate the state of the hand trauma system by examining articles that reported on access to hand trauma care. METHODS We conducted a literature review on hand trauma care using PubMed, Ovid MEDLINE, and EMBASE databases. We included English language articles from the U.S. that described access to hand trauma care in the emergency health system. RESULTS Fourteen studies met our inclusion criteria. Ten studies evaluated access to hand trauma care on a patient level. Of these 10 studies, five reported on access to care for transferred patients and five reported on access to care for patients with amputation injuries. The other four studies evaluated access to hand trauma care at a hospital level. CONCLUSIONS Lack of hand trauma guidelines at emergency departments and a severe shortage of on-call hand specialists at community hospitals and trauma centers have created a suboptimal system of hand emergency care in the U.S. The current system of hand trauma care in the U.S. may not only drive up the cost of care but may also adversely affect patients’ health and well-beings.

Annual Hospital Volume and Success of Digital Replantation

“…3–5 Declining trends in digit replantation have been linked to rising health care costs, scarcity and maldistribution of hand surgeons with microsurgical skills, low reimbursement rates for digit replantation, and unavailability of on-call hand surgeons in many hospitals. 5–7 …”

A Population-Based Study of Replantation After Traumatic Thumb Amputation, 2007–2012

“…Thumb replantation is commonly indicated for thumb amputations in stable patients. The 3 main findings of this study were (1) the rate of attempted thumb replantation remained about the same, decreasing slightly from 37% in 2007 to 34% in 2012; (2) having no insurance reduced the probability of undergoing thumb replantation by 50%; (3) treatment in highvolume, teaching, level-I trauma hospitals compared with nonteaching and nonelevel-I trauma centers increased the probability of attempted replantation.…”

“…Third, we ran a 2-level mixed logistic model (level I includes patient characteristics and level II includes hospital characteristics) to adjust for potential correlation owing to repeated measures for each hospital. In addition, we performed 3 sensitivity analyses: (1) we used a simple logistic model with clustered variance (vce (cluster)) 28 to adjust for repeated measures; (2) we ran a simple logistic model with clustered variance among the 97 hospitals that stayed in the database between 2007 and 2012; and (3) we used treatment effect estimate (teffects), 29 using African American 100 (7) 46 (6) Other race 217 (14) 131 (16) Race not specified 122 (8) 59 (7) Health (29) No insurance 320 (21) 127 (16) Medicaid 111 (7) 61 (8) Workers' compensation 307 (20) 181 (22) Other insurance 253 (17) 140 (17) Not specified 166 ( inverse propensity score weighting to estimate the average treatment effect for uninsured patients, assuming all other patient and hospital characteristics were the same between uninsured and insured patients. Table 1 shows the characteristics of patients with traumatic thumb amputation injuries.…”

“…We examined variations in treatment procedure adjusting for relevant patient and hospital characteristics. The 3 specific aims of this study were (1) to examine the most recent trends in prevalence of thumb replantation versus revision amputation, (2) to examine patient and hospital characteristics that were associated with replantation attempts, and (3) to specifically examine the association between insurance and replantation as a recommended treatment for thumb amputation. We predicted that attempted replantation rates would decrease throughout our study period.…”

Treatment of Defects on the Volar Surface of the Finger using the Dorsal Digital–metacarpal Flap Versus the Free Medial Plantar Artery Flap: A Comparative Study

“…Hand trauma accounts for about 12% of all trauma cases and is the most common reason for emergency treatment, accounting for about 1/5 of all emergency patients [10,11]. The results of defect coverage are closely related to the patient's quality of life, functional recovery, and appearance.…”