C. Kerby1, K. E. Leibl3, E. K. Awad2, T. A. Swain1, R. L. Griffin1, T. W. King1 1University Of Alabama at Birmingham,Birmingham, Alabama, USA 2University Of South Alabama,Mobile, AL, USA 3University Of Wisconsin,Madison, WI, USA
Introduction: It has been shown previously that disparities exist in treatment and access to care by race, insurance coverage, and age in the United States. Our objective was to evaluate if treatment and time to treatment disparities exist in patients sustaining injuries below the elbow managed at a single level 1 trauma center in the United States.
Methods: The number of upper limb injuries below the elbow seen at a level 1 trauma center from 2010-2014 were determined using the trauma registry. Injuries were defined as any injury in the upper extremity below the elbow and were identified by anatomical region using the abbreviated injury scale (AIS). Only anatomical regions clearly defined by AIS which were below the elbow were used; therefore, whole limb categories were excluded as well as injuries specific to vessels, nerves, and skin since AIS does not specify anatomical regions for these structures below the elbow. ICD-9 procedural codes for amputation on the upper limb were used to identify patients undergoing amputation. Patient demographic, injury, and clinical variables were compared by amputation procedure status using the chi-square and t-test for categorical and continuous variables, respectively.
Results: There were 2059 patients from 2010 to 2014, which had an upper extremity injury below the elbow. Of these patients, 77 (3.7%) required an amputation. Injury severity score was significantly higher (p<0.0001) for those who did not undergo amputation (14.8) when compared to those who did (6.0). Time to admission from injury was also longer for those not undergoing amputation (0.3 days) compared to those undergoing amputation (0.1 days) (p=0.0005). Those who underwent amputation were more likely to be male (80.5%) (p=0.0244). There was no difference for race (p=0.7326), age (p=0.8724), hospital LOS (p=0.0834), ICU LOS (p=0.1463), or time to admission from injury (p=0.4501). Payment type differed significantly by amputation procedure status (p<0.0001), with 23.4% of those amputated paying through workers’ compensation, compared with only 4.6% among those not amputated.
Conclusion: Amputation is uncommon following upper extremity injury below the elbow. Ironically, the ISS was lower for patients receiving amputations. This likely implies, but can not be absolutely concluded, that the below elbow amputation injury was an isolated injury Those requiring amputation were more likely male, presented for treatment sooner, and were more often associated with a work-related injury. This data does not support previous studies’ findings of racial or age disparities. However, this analysis is limited by being at a single center and the limitations associated with the AIS. Further investigations utilizing a multicenter, nationwide database should be performed to verify and validate these results.