Adkinson, Joshua M, MD

Eid, Sherrine, MPH

Miles, Marshall G, DO

Shafqat, Muhammad Shuja, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryDelayed Diagnosis of Hand Injuries in PolytraumaPatients (Poster)Joshua M. Adkinson MDLehigh Valley Health NetworkMuhammad Shuja Shafqat MDLehigh Valley Health Network, Mohammad_S.Shafqat@lvhn.orgSherrine Eid MPHLehigh Valley Health Network, Sherrine.Eid@lvhn.orgMarshall G. Miles DOLehigh Valley Health Network, Marshall.Miles@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/surgeryPart of the Other Medical Specialties Commons, and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtAdkinson, J., Shafqat, M., Eid, S., & Miles, M. (2011, October 20-23). Delayed diagnosis of hand injuries in polytrauma patients.Presented at the 28th Annual Meeting of the Northeastern Society of Plastic Surgeons, Amelia Island, FL.Delayed Diagnosis Of Hand Injuries In Poly-Trauma PatientsJoshua M. Adkinson, MD, M. Shuja Shafqat, MD, Sherrine M. Eid, MPH and Marshall G. Miles, DO, Lehigh Valley Health Network, Allentown, Pa.AbstractHand injuries represent 5-10% of emergency room visits in the U.S. with signifi cant eco-nomic effects. Trauma patients are at high risk for delayed diagnosis of concomitant  injuries, including hand injuries, with reports in the literature as high as 50%. Our goal was to examine the risk factors for and  incidence of the delayed diagnosis of hand injuries at a Level 1 Trauma Center. A retro-spective review was performed on all admitted trauma patients from 2000 through 2009. Patient demographics, ISS, GCS, injury  specifi cs, length of stay, and timing of hand injury diagnosis related to admission date were noted. With an increase in ISS and a decreased GCS, trauma patients are increas-ingly at risk for delayed diagnosis of hand  injuries with a concomitantly increased length of stay. As a delayed diagnosis of hand injuries has signifi cant physical and economic implications for patients, every  effort should be made to expedite diagnosis in the poly-trauma patient. A standardized evaluation of the trauma patient with a  focused tertiary survey is mandatory, par-ticularly with an altered mental status or multiple injuries. Introduction•  Trauma patients are at a risk as high as 50% for delayed diagnosis of concomitant injuries and including hand injuries.•  Head injury and Glasgow Coma Score of ≤ 8, a greater Injury Severity Score, and childhood have been implicated as risk factors for missed injuries in poly-trauma patients.•  If diagnosis is delayed, patients may have a prolonged period of disability and longer hospital stays with associated increased cost.Objective•  To examine the risk factors for and incidence of the delayed diagnosis of hand injuries at a Level 1 Trauma Center. Methodology•  Retrospective review of admitted trauma patients with hand injuries from  January 1, 2000 through December 31, 2009• Patients were assessed for :  Age  Gender  Blood alcohol level  Glasgow Coma Score (GCS)  Injury Severity Score (ISS)  Mechanism, injury type  Length of stay (LOS)  Timing of hand injury diagnosis•  ISS scores were subcategorized into mild (<9), moderate (9-16), and severe (>16).•  A multiple linear regression model was used to determine risk factors for  delaying the diagnosis of hand injuries using SPSS 15.0.Exclusion Criteria • Isolated or conspicuous hand injuries. • Distal radius fracturesResults•  36,568 patients identifi ed with 2736 with hand injuries. 738 patients met  inclusion criteria.Table 3: Group ComparisonsDelayed Diagnosis N MeanStd. Deviationp valueAgeYes 160 47.84 21.913.160No 578 44.96 23.244GCSYes 156 12.95 4.027<.001No 535 14.16 2.698ETOHYes 111 57.73 92.459.300No 313 47.50 88.036ISSYes 160 17.57 10.864<.001No 578 12.81 8.765LOSYes 160 10.41 11.024<.001No 578 5.99 7.604Discussion•  78.3% of patients were diagnosed on the day of admission, with 91.3% diagnosed by the  following day. •  Patients with a decreased GCS and elevated ISS were noted to have a statistically signifi -cant  delay in diagnosis. •  Length of hospitalization was also noted to be longer in the subset of patients with a delayed diagnosis of hand injuries. •  Metacarpal fractures were the predominant  injury in our study and also the most likely in-jury to be initially missed. •  Motor vehicle collisions were the most common mechanism for injury in our patient population and the most common mechanism associated with a delay in diagnosis.Limitations•  Retrospective review•  Unable to assess function outcomes or if  patients required surgical intervention as a  result of delayConclusions•  With an increase in ISS and a decreased GCS, trauma patients are increasingly at risk for  delayed diagnosis of hand injuries with a  concomitantly increased length of stay. •  Every effort should be made to expedite  diagnosis in the poly-trauma patient. •  A standardized evaluation of the trauma patient with a focused tertiary survey is mandatory,  particularly in patients with an altered mental status or with multiple injuries. •  In this subset of patients, however, a short  delay in the diagnosis of hand injuries may be unavoidable.Table 2: Day of Hand Injury DiagnosisDay Frequency % Cumulative %0 578 78.3 78.31 96 13.0 91.32 29 3.9 95.33 9 1.2 96.54 6 .8 97.35 3 .4 97.76 4 .5 98.27 4 .5 98.89 1 .1 98.910 2 .3 99.211 1 .1 99.312 1 .1 99.513 3 .4 99.915 1 .1 100.0Total 738 100.0Table 1: DemographicsN MeanAge 738 45.59LOS 738 6.95Diagnosis of Injury(Hospital day #) 738 .51ISS 738 13.84ETOH 424 50.17GCS 691 13.89Table 4: Logistic Regression Model (p<0.001) Delayed Hand Injury Diagnosis p valueAdjusted OR95% Confi dence Interval for Adjusted ORIntercept .004GCS .035 .934 .877 .995Age .001 1.020 1.008 1.032Severely Injured .015 2.014 1.144 3.549Moderately Injured .050 1.890 .999 3.575Mildly InjuredAlcohol Use .058 1.605 .985 2.617No Alcohol UseFemale .057 1.610 .985 2.629MaleTable 5: Delayed Diagnosis by ISS Category Crosstabulation (p<0.001)ISS CategoryTotalMild Moderate SevereDelayed DiagnosisYesN 50 33 77 160% within Delayed Diagnosis 31.3% 20.6% 48.1% 100.0%% within ISS Category 14.4% 24.1% 30.4% 21.7%NoN 298 104 176 578% within Delayed Diagnosis 51.6% 18.0% 30.4% 100.0%% within ISS Category 85.6% 75.9% 69.6% 78.3%TotalN 348 137 253 738% within Delayed Diagnosis 47.2% 18.6% 34.3% 100.0%% within ISS Category 100.0% 100.0% 100.0% 100.0%

Delayed Diagnosis of Hand Injuries in Polytrauma Patients (Poster)

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1150&context=surgery

Delayed Diagnosis of Hand Injuries in Polytrauma Patients (Poster)

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