title: Differences in treatment of digital amputation injuries based on community transfer versus tertiary initial presentation.
abstract: BACKGROUND
  The purpose of this paper is to compare a group of patients with upper extremity amputation injuries who presented to a tertiary referral center without having been previously seen at another hospital versus a group of patients who was transferred from another facility. We hypothesize that transferred patients will generally undergo more complex treatments, that some transferred patients will be treated in the ER with simple treatments (thereby perhaps not requiring transfer), and that transferred patients will be less likely to have insurance coverage.
  
  
  METHODS
  All patients who presented to our ER from January 1, 2007 to December 31, 2008 with the classification of hand and finger amputation were included. Data collected included whether or not the patient was transferred from another institution, age, mechanism of injury, partial versus total amputation, location treated, transportation method, general treatment classification, type of insurance, and month of presentation.
  
  
  RESULTS
  No statistical difference was found between patients who were transferred versus those who were not with respect to age, sex, mechanism, whether the amputation was partial versus complete, or insurance coverage. Statistical differences were noted between the subset of patients who was transferred versus those who were not with respect to treatment location, method of transportation, and treatment.
  
  
  CONCLUSIONS
  Patients transferred to our institution required significantly more complex treatments and were significantly more likely to be treated in the operating room. A small but significant group of patients was treated in the ER or required relatively simple treatments after transfer. Our hypothesis that a higher percentage of patients transferred to our institution would have less insurance coverage was not supported by the data. Tertiary centers can expect to continue receiving a steady stream of amputation referrals.
authors.affiliation: Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Box 359798, 325 Ninth Ave., Seattle, WA 98104 USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Amis
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Friedrich
keywords: Digital amputation; Hand amputation; Transfer; Treatment