Hand trauma: A prospective observational study reporting diagnostic concordance in emergency hand trauma which supports centralised service improvements

Miranda, BH, Spilsbury, ZP, Rosala-Hallas, A ORCID: 0000-0001-8012-9995 and Cerovac, S (2016) Hand trauma: A prospective observational study reporting diagnostic concordance in emergency hand trauma which supports centralised service improvements. JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, 69 (10). pp. 1397-1402.

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Abstract

<h4>Background</h4>Hand injuries are common, contributing up to 30% of accident and emergency (A&E) attendances. The aim of this study was to prospectively analyse the pathological demographics of hand injuries in a level 1 trauma centre with a Hand Trauma Unit and direct A&E links, and compare clinical and intra-operative findings. The null hypothesis was that there would be no differences between clinical and intra-operative findings (100% diagnostic concordance).<h4>Methods</h4>Data were prospectively collected for referrals during 2012. Referral diagnosis, additional pathologies found on clinical assessment and intra-operative findings were documented on a live database accessible from both the Hand Unit and associated operating theatres. Odds ratios were calculated using SAS.<h4>Results</h4>Injuries (1526) were identified in 1308 patients included in the study. Diagnostic concordance between Hand Unit clinical examination and intra-operative findings was 92.5% ± 2.85% (mean ± SEM); this was lower for flexor tendon injuries (56.3%) because a greater number of additional pathologies were found intra-operatively (2.25 ± 0.10). This 'trend' was noted across multiple referral pathologies including phalangeal fractures (1.28 ± 0.02; 82.9%), lacerations (1.33 ± 0.04; 79.1%), extensor tendon injuries (1.30 ± 0.05; 87.8%) and dislocations (1.18 ± 0.05; 87.8%). Odds ratio analysis indicated a relationship between primary referral diagnoses that were more or less likely to be associated with additional injuries (p < 0.05); referral diagnoses of flexor tendon injuries and lacerations were most likely to be associated with additional injuries.<h4>Conclusions</h4>As hand injuries are a common presentation to A&E departments, greater emphasis should be placed on training clinicians in the management of hand trauma. Our findings, coupled with the presented relevant literature reports, lead us to advocate that A&E departments should move towards a system wherein links to specialist hand trauma services are in place; we hereby present useful data for hospitals implementing such services.

Item Type:	Article
Uncontrolled Keywords:	Hand trauma, Diagnosis, Management, Service provision, Trauma centre
Depositing User:	Symplectic Admin
Date Deposited:	23 Aug 2017 08:43
Last Modified:	19 Jan 2023 07:03
DOI:	10.1016/j.bjps.2016.06.030
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3007882