title: Lack of Acute Hand Care in the Southwest United States.
abstract: OBJECTIVE
  To describe the epidemiology of acute hand injuries and hand infections and to describe the factors associated with the transfer of these patients to a level 1 trauma center. In addition, we sought to understand management before transfer.
  
  
  METHODS
  Retrospective review of patients with hand trauma or hand infection transferred to our level 1 trauma center from May 2009 to August 2011. We also identified hospitals with emergency departments (EDs) in our region and surveyed ED providers in these hospitals with regard to acute hand care.
  
  
  METHODS
  A level 1 trauma center in the United States.
  
  
  METHODS
  Four hundred sixty consecutive transfers for acute hand care.
  
  
  RESULTS
  The average patient age was 38. Most were male (84%), uninsured (51%), and from another county (59%). The average distance of transfer was 51 miles, and 80% were transferred by ground ambulance. The most common reasons for transfer were amputations (24%), infections (21%), lacerations (17%), and fractures/dislocations (16%). Of the 345 hospitals with an ED surveyed, 71% never had hand surgery coverage.
  
  
  CONCLUSIONS
  Patients transferred for acute hand care were young and male, and traveled an average 51 miles to get to our center. More than half of these patients were treated and discharged from our ED. This indicates that a majority may have been managed in a clinic setting. Most EDs in our region do not have a hand surgeon available. Most emergency physicians surveyed had received little training in management of acute hand injuries and hand infections. Further research is needed to identify methods to remove barriers to provision of care for patients with hand trauma.
  
  
  METHODS
  Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Brown
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Hinojosa
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Cline
authors.forename: Sheena R
authors.initials: SR
authors.lastname: Black
authors.forename: Marissa D
authors.initials: MD
authors.lastname: Jamieson
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Starr
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D003422:Critical Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006230:Hand Injuries / Q000453:epidemiology* / Q000601:surgery*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D019637:Orthopedic Procedures; D010360:Patient Transfer / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D015206:Southwestern United States / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014195:Travel / Q000706:statistics & numerical data; D055815:Young Adult