Referral Patterns Associated With Delayed Care for Traumatic Brachial Plexus Injuries.
Brian W Yang1, Rafa Rahman1, Casey Urban1
1Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY.
The Journal of Hand Surgery
|June 30, 2023
Summary
Delays in treating traumatic brachial plexus injuries (BPI) worsen outcomes. Ordering diagnostic EMG tests before referral to a specialized center increases patient delays for BPI treatment.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Trauma Surgery
Background:
- Traumatic brachial plexus injuries (BPI) are severe and time-sensitive.
- Prompt treatment at specialized centers is crucial for optimal outcomes.
- Delays in presentation and surgery are linked to poorer results.
Purpose of the Study:
- To investigate referral patterns contributing to delayed presentation and surgery in traumatic BPI patients.
- To identify factors associated with delayed care for these injuries.
Main Methods:
- Retrospective review of 99 traumatic BPI patients (2000-2020).
- Analysis of demographic data, pre-referral work-up, and referring provider characteristics.
- Multivariable logistic regression to determine factors linked to delayed presentation (>3 months) or late surgery (>6 months).
Main Results:
- 62.6% of patients experienced delayed presentation, and 36.6% had late surgery.
- Referral provider specialty did not significantly impact delay rates.
- Patients whose initial diagnostic EMG was ordered by the referring provider showed higher rates of delayed presentation (76.2%) and late surgery (44.9%).
Conclusions:
- Initial diagnostic EMG ordered by referring providers is associated with delayed presentation and surgery in traumatic BPI cases.
- Direct referral to brachial plexus centers without prior work-up is recommended to improve patient outcomes.
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