title: Hand Trauma Care in the United States: A Literature Review.
abstract: BACKGROUND
  Hand trauma is one of the most complex injuries treated in the emergency department. Hand trauma injuries are time sensitive and require highly specialized care. Patients may have difficulty accessing appropriate hand trauma care because of a variety of factors. The authors aimed to evaluate the state of the hand trauma system by examining articles that reported on access to hand trauma care.
  
  
  METHODS
  The authors conducted a literature review on hand trauma care using the PubMed, Ovid MEDLINE, and Embase databases. The authors included English language articles from the United States that described access to hand trauma care in the emergency health system.
  
  
  RESULTS
  Fourteen studies met the authors' inclusion criteria. Ten studies evaluated access to hand trauma care on a patient level. Of these 10 studies, five reported on access to care for transferred patients and five reported on access to care for patients with amputation injuries. The other four studies evaluated access to hand trauma care at a hospital level.
  
  
  CONCLUSIONS
  Lack of hand trauma guidelines at emergency departments and a severe shortage of on-call hand specialists at community hospitals and trauma centers have created a suboptimal system of hand emergency care in the United States. The current system of hand trauma care in the United States not only may drive up the cost of care but may also adversely affect patients' health and well-being.
authors.affiliation: Ann Arbor, Mich. From the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School; and the Taubman Health Sciences Library, University of Michigan Health System.
authors.forename: Brianna L
authors.initials: BL
authors.lastname: Maroukis
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: Mark
authors.initials: M
authors.lastname: MacEachern
authors.forename: Elham
authors.initials: E
authors.lastname: Mahmoudi
mesh_terms: D004632:Emergency Medical Services / Q000458:organization & administration*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D014193:Trauma Centers; D014194:Traumatology / Q000379:methods*; D014481:United States