Hand trauma: a prospective evaluation of patients transferred to a level I trauma center

We conducted this study to evaluate the hypothesis that the need for a higher level of care is the most important reason for the transfer of patients with hand trauma to a level I trauma center. We prospectively assessed 53 patients transferred to our level I trauma center for evaluation of an acute hand injury. Specialty of referring physician, case complexity as assessed with visual analog scale, and patient insurance status were obtained before transfer and were reassessed after arrival. Only 9 patients were examined by a surgeon before transfer. On the basis of injury severity, we judged that 40 of the 53 patients required the immediate care of a hand surgeon but that only 13 required the resources of a level I trauma center. Most of the patients were transferred without prior evaluation by a hand surgeon, despite there being an on-staff surgeon at many of the hospitals.