Hand Trauma Referral and Processes: Lessons from the Global Community: Narrative Review
Abstract
Background:
The global recorded incidence of hand trauma is 2 million cases annually (Telich-Tarriba et al., 2018), and there is a noticeable increase in incidence in developing countries compared to developed countries (Dias, 2006). Inadequate management of such cases could lead to a significant disability and negatively affect the quality of life (Colen, 2018; Crowe, 2020; McDonald, 2020). Hand trauma is one of the injuries that incur the highest economic burden; the estimated median cost of all hand injury types is 6951 United States Dollars (USD) per patient (Robinson, 2016), while the cost of emergency department visits for hand trauma in the United States is estimated to be over 100 billion USD (Colen et al., 2018). The burden of hand trauma on developing countries is more prominent and significantly impacts individuals and the health system (Siotos et al., 2018). Hand trauma can be adequately managed in a well- coordinated system without expensive resources. Many improvement strategies were developed in high-income countries to manage the load of hand trauma, whereas there is a substantial lack of data from low-resource settings.
Aim:
This review aims to study the global evidence on interventions to manage hand trauma, including referral protocols and processes, comparing evidence from high- and low-resource settings, and inform future improvement plans.
Methods:
A systematic search of published and unpublished sources and grey literature databases was undertaken to identify relevant studies. A narrative synthesis of data was completed to structure the evidence into different topics.
Results:
The studies included in this review are 50 references. The results are sorted into five sections including, an overview of the economic and health system impacts of hand trauma, hand trauma care in high-income countries, the different strategies and processes used to improve hand trauma care and referral in high-income countries, hand trauma care in low- and middle- income countries, and the pattern of surgical referral and improvement strategies in low- resource settings.
Conclusion:
While hand trauma is an unavoidable injury, there is no global standard management protocol or referral guideline for managing a large number of cases, causing a significant burden on the health system by unnecessarily crowding emergency departments or incurring massive expenses due to hand disabilities. Evidence from high-income countries suggests that developing referral guidelines, telecommunication, and acute hand trauma clinic could reduce the burden of such injuries and improve their outcomes.