The Lack of Acute Hand Care in the Southwest United States

OBJECTIVES:: To describe the epidemiology of acute hand injuries and infections and to describe the factors associated with the transfer of these patients to a level one trauma center. Additionally we sought to understand management prior to transfer. DESIGN:: Retrospective review of hand trauma and infection patients transferred to our level one trauma center from May 2009 to August 2011. We also identified hospitals with emergency rooms in our region and surveyed emergency room (ER) providers in these hospitals with regard to acute hand care. SETTING:: A level one trauma center in the United States PATIENTS:: 460 consecutive transfers for acute hand care RESULTS:: The average patient age was 38. The majority were male (84%), uninsured (51%), and from another county (59%). The average distance of transfer was 51 miles, and 80% were transferred via ground ambulance. The most common reasons for transfer were amputations (24%), infections (21%), lacerations (17%), and fractures/dislocations (16%). Of the 345 hospitals with an emergency department surveyed, 71% never had hand surgery coverage. CONCLUSIONS:: Patients transferred for acute hand care were young, male, and traveled an average 51 miles to get to our center. More than half of these patients were treated and discharged from our emergency room. This indicates a majority may have been managed in a clinic setting. Most emergency rooms in our region do not have a hand surgeon available. Most emergency physicians surveyed had received little training in management of acute hand injuries and infections. Further research is needed to identify methods to remove barriers to provision of care for hand trauma patients. LEVEL OF EVIDENCE:: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.