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Limited hand surgery, microvascular/replantation on-call resources seen at trauma centers

Issue: October 2011

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Bret C. Peterson

LAS VEGAS — The availability of on-call resources for emergency hand surgery and microvascular/replantation services at U.S. trauma centers remains inconsistent, according to recently presented findings on level 1 and 2 institutions.

Bret C. Peterson, MD, presented his team’s research at the 2011 Annual Meeting of the American Society for Surgery of the Hand.

“Less than half of the 117 level 1 trauma centers in the United States have full-time microvascular/replantation call coverage. There are an additional 8% of institutions with inconsistent coverage,” Peterson said. “Twenty-nine percent of the level 2 trauma centers have full-time microvascularization services. An additional 7% have inconsistent coverage. We also concluded that hand call and emergency microvascular/replantation call is not consistently defined.”

To determine the availability of emergency hand and microsurgical call coverage, Peterson and colleagues conducted an unannounced, anonymous, telephone survey of all level 1 and 2 trauma centers in the United States between May and December 2010. Respondents were asked about the availability of a hand and microvascular/replantation surgeon at the time of the call and during the past or current month. Eighty-five percent of all level 1 and 86.3% of level 2 trauma centers participated in the study.

Of the level 1 centers, 47% had full-time coverage and 45% had no emergency coverage. Rates for the level 2 centers were 29% and 64%, respectively.

“Our study findings suggest the need to consider standardization of terminology, a need to define what is hand surgery call, and is this separate or is this just included in emergency microvascular/replantation call,” Peterson said.

The investigators also recommended a hand trauma designation system and the creation of a coordinated regional hand trauma system.

Reference:

• Peterson BC, Mangiapani D, Kellogg R, Leversedge FJ. Hand and microvascular-replantation call availability study: A national real-time survey of level 1 and 2 trauma centers. Paper #1. Presented at the 2011 Annual Meeting of the American Society for Surgery of the Hand. September 8-10. Las Vegas.

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