title: A descriptive study of hand injuries presenting to the adult emergency department of a tertiary care center in urban India.
abstract: BACKGROUND
  Despite having a dedicated Plastic Surgery Unit, emergency physicians (EPs) manage many of the acute, traumatic hand injuries. Further very minimal information exists about the extent to which tetanus recommendations as per Advisory Committee on Immunization Practices are followed in emergency departments (EDs). Furthermore, the management of pain is often neglected.
  
  
  OBJECTIVE
  To provide a clinical description of hand injuries with etiology and mechanism; and describe the trends of ED management, including analgesia and tetanus prophylaxis.
  
  
  METHODS
  Records of eighty patients with hand injuries were reviewed. SPSS version 18 was used for statistical analysis. Wilcoxon signed rank test, and Pearson Chi-square test were used to compare left with right-hand injuries and validate associations, respectively.
  
  
  RESULTS
  The mean age of the patients was 27.41 years and median delay in presentation was 2 h. Occupational injury was the predominant mode of injury (74%) most patients (59 of the 86) received intravenous analgesia; while very few (6) received local anesthesia and (24) received no analgesia at all. A majority of patients (56) received tetanus toxoid prophylaxis, while only four patients (4.6%) also received tetanus immunoglobulin intramuscular. Most patients (71%) were admitted, while only a small number of patients (14%) were discharged from the ED.
  
  
  CONCLUSIONS
  Proper training and sensitization towards the need and technique of anesthesia (particularly local anesthesia) would improve the quality of patient care. Printed guidelines and periodic review of the charts would help to overcome poor adherence to tetanus prophylaxis. Hand injuries could be managed better by the EP, with training through rotations to the Plastic Surgery Unit.
authors.affiliation: Department of Emergency Medicine, St. John's Medical College, Bengaluru, Karnataka, India.
authors.forename: Murtuza N
authors.initials: MN
authors.lastname: Ghiya
authors.affiliation: Department of Emergency Medicine, St. John's Medical College, Bengaluru, Karnataka, India.
authors.forename: Shakuntala
authors.initials: S
authors.lastname: Murty
authors.affiliation: Department of Plastic Surgery, St. John's Medical College, Bengaluru, Karnataka, India.
authors.forename: Naren
authors.initials: N
authors.lastname: Shetty
authors.affiliation: Department of Emergency Medicine, St. John's Medical College, Bengaluru, Karnataka, India.
authors.forename: Rodney
authors.initials: R
authors.lastname: D'Cunha
keywords: Analgesia; emergency department; hand injuries; tetanus prophylaxis