Lack of Acute Hand Care in the Southwest United States

Brown, Timothy S.; Hinojosa, Lauren S.; Cline, Kelly E.; Black, Sheena R.; Jamieson, Marissa; Starr, Adam J.

doi:10.1097/bot.0000000000000487

Cited by 8 publications

(10 citation statements)

References 10 publications

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“…Many studies have demonstrated that patients presenting with hand injuries to an emergency department often do not require a hospital admission. 1,3,15,16,39,40 Despite this trend, a large number of patients were still found to undergo imaging studies and specialty consultation. 15,40 Most patients were treated and discharged from an emergency department, indicating that many can be managed in a clinic setting.…”

Section: Discussionmentioning

confidence: 99%

“…15,40 Most patients were treated and discharged from an emergency department, indicating that many can be managed in a clinic setting. 3…”

Section: Discussionmentioning

confidence: 99%

“…Challenges that particularly affect the ability for patients to access high-quality surgical hand care, both in an emergency and elective setting, include on-call surgical workforce shortages and geographic maldistribution, overuse of emergency departments, distance to definitive care, uncompensated physician and hospital reimbursement, increasing malpractice costs, and uncertainty of the impact of the Affordable Care Act (ACA). 3 , 6 -9…”

Section: Introductionmentioning

confidence: 99%

“…1 Multiple studies have found that complaints related to the hand are among the most prevalent reasons for presentation to an emergency department. [1][2][3] Hand injuries are often lacerations, occur due to occupational hazards, and in a younger population. 3 In addition, the prevalence of nontraumatic hand disorders such as carpal tunnel syndrome and trigger finger are on the rise in the United States.…”

Section: Introductionmentioning

confidence: 99%

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Access to Reconstructive Hand Surgery in the United States—Investigating the Obstacles: A Scoping Review

Kohan

Mangan

Patel

2022

Hand (New York, N,Y.)

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Background: Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation. Methods: The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence. Results: Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature. Conclusions: This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.

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Section: Discussionmentioning

confidence: 99%

“…15,40 Most patients were treated and discharged from an emergency department, indicating that many can be managed in a clinic setting. 3…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Access to Reconstructive Hand Surgery in the United States—Investigating the Obstacles: A Scoping Review

Kohan

Mangan

Patel

2022

Hand (New York, N,Y.)

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“…The surgical treatment of hand infections is complex and challenging due to the intricate anatomy involved, the low tolerance for adhesions, and the potential for long-term morbidity. They serve as a common etiology for emergency department admissions 1 and tend to occur in younger males (median age 36e40), with as much as 89% male predominance. 1e3 Because of the impact on patient lifestyle, executive function, and survival, appropriate treatment must be given in a timely manner.…”

Section: Introductionmentioning

confidence: 99%

Differences in the Predictive value of Elixhauser Comorbidity Index and the Charlson Comorbidity indices in patients with hand infections

Congiusta

Amer

Otero

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Hand infections are a common source of potentially debilitating morbidity, particularly in patients with comorbid disease. We hypothesize that there is a difference in predictive value between two commonly used comorbidity indices for the prognosis of hand infections, which may have clinical implications in the management of these conditions. Methods: The Nationwide Inpatient Sample 2001e2013 database was queried for hand infections using International Classification of Diseases, Ninth Revision codes. The Elixhauser (ECI) and Charlson (CCI) comorbidity scores were calculated based on validated sets of ICD-9 codes. Primary outcomes included mortality, prolonged length of stay (LOS, defined as >95 percentile), discharge destination, and postoperative complications. Indices were compared using receiver operating characteristic (ROC) curves and the areas under the curve (AUC). If confidence intervals overlapped, significance was determined using the DeLong method for correlated ROC curves. This is a validated, non-parametric comparison used for the calculation of the difference between two AUCs. Results: A weighted total of 1,511,057 patients were included in this study. The majority were Caucasian (57.1%) males (61.4%). Complication rates included 0.9% mortality, 5.3% prolonged length of stay, 25.3% discharges to non-home destinations, and 5.3% post-operative complications. The ECI and CCI each demonstrated good predictive value for mortality, but poor predictive value for non-routine discharge, prolonged LOS, and post-operative complications. There was a significantly increased likelihood of each complication with increasing comorbidity score for both indices, with the greatest odds ratio in the ECI !4 cohort. Conclusions: The CCI was superior in predicting mortality while the ECI was superior in predicting nonroutine discharge, prolonged length of stay, and postoperative complications, but these indices may not be clinically relevant. While both represent good predictive models, a score specifically designed for patients with hand infections may have superior prognostic value. Level of evidence: Level IV.

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Upper limb amputation; Care needs for reintegration to life: An integrative review

Shahsavari

Matourypour

Ghiyasvandian

et al. 2020

International Journal of Orthopaedic and Trauma Nursing

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Lack of Acute Hand Care in the Southwest United States

Abstract: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 8 publications

References 10 publications

Access to Reconstructive Hand Surgery in the United States—Investigating the Obstacles: A Scoping Review

Access to Reconstructive Hand Surgery in the United States—Investigating the Obstacles: A Scoping Review

Differences in the Predictive value of Elixhauser Comorbidity Index and the Charlson Comorbidity indices in patients with hand infections

Upper limb amputation; Care needs for reintegration to life: An integrative review

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