title: Emergency Department Wait Time and Treatment of Traumatic Digit Amputation: Do Race and Insurance Matter?
abstract: BACKGROUND
  Little is known about the association between the quality of trauma care and management of nonfatal injuries. The authors used emergency department wait times as a proxy for hospital structure, process, and availability of on-call surgeons with microsurgical skills. They evaluated the association between average hospital emergency department wait times and likelihood of undergoing digit replantation for patients with traumatic amputation digit injuries. The authors hypothesized that hospitals with shorter emergency department wait times were associated with higher odds of replantation.
  
  
  METHODS
  Using the 2007 to 2012 National Trauma Data Bank, the authors' final sample included 12,126 patients. Regression modeling was used to first determine factors that were associated with longer emergency department wait times among patients with digit amputation injuries. Second, the authors examined the association between emergency department wait times for this population at a hospital level and replantation after all types of digit amputation and after complicated thumb amputation injuries only.
  
  
  RESULTS
  For patients with simple and complicated thumb amputation injuries, and patients with complicated thumb amputation injuries only, longer emergency department wait times were associated with lower odds of replantation. In addition, being minority and having no insurance were associated with longer emergency department wait times; teaching hospitals were associated with shorter emergency department wait times; and finally, for patients with complicated thumb amputation injuries only, there was no association between patients' minority or insurance status and replantation.
  
  
  CONCLUSIONS
  Variation in emergency department wait time and its effects on treatment of traumatic digit amputation may reflect maldistribution of hand or plastic surgeons with the required microsurgical skills among trauma centers across the United States.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Ann Arbor, Mich.|From the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School.
authors.forename: Elham
authors.initials: E
authors.lastname: Mahmoudi
authors.affiliation: Ann Arbor, Mich.|From the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Swiatek
authors.affiliation: Ann Arbor, Mich.|From the Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012092:Replantation / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States; D055815:Young Adult