Upper Extremity Injuries Seen at a Level 1 Trauma Center: Does Insurance Status Matter?

Hand and upper extremity injuries are one of the leading causes of injury in the United States, making up 10% of all emergency department visits. The purpose of this study was to determine if there are any demographic differences between patients presenting primarily to our emergency department for upper extremity injuries versus those transferred from outside hospitals for the same diagnoses.

A retrospective review of our hand trauma database was performed between 2011 and 2014. All patients within this period with International Classification of Disease 9 codes consistent with upper extremity injuries were included in this study. Patients were stratified into 2 groups: those who first presented to another hospital and accepted as transfers to our institution (group 1) and those presenting directly to our emergency department (group 2). Demographic data were collected for each group including sex, age, race, insurance status, mechanism, need for emergent surgery, and day and time of presentation. The groups were analyzed using odds ratios with a 95% confidence interval and paired t test for continuous variables.

One hundred thirty-nine patients with isolated upper extremity injuries were accepted for transfer from an outside hospital, and 419 patients presented directly to our institution. The average age of group 1 was 38 (77% M, 23% F) compared with 41 (73% M, 27% F) for group 2. Forty percent of group 1 patients were uninsured compared with 17% for group 2. There was a significant difference between groups (P < 0.05).

The data suggest that our institution receives a large proportion of uninsured patients transferred for emergent upper extremity care compared with our current patient demographic. Because this is a retrospective study, the precise reason for these discrepancies will remain unknown.