Referral Patterns Associated With Delayed Care for Traumatic Brachial Plexus Injuries

Brian W Yang; Rafa Rahman; Casey Urban; Christian Victoria; Steve K Lee

doi:10.1016/j.jhsa.2023.05.007

Referral Patterns Associated With Delayed Care for Traumatic Brachial Plexus Injuries

J Hand Surg Am. 2023 Jun 29:S0363-5023(23)00257-5. doi: 10.1016/j.jhsa.2023.05.007. Online ahead of print.

Authors

Brian W Yang¹, Rafa Rahman¹, Casey Urban¹, Christian Victoria¹, Steve K Lee²

Affiliations

¹ Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY.
² Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY. Electronic address: lees@hss.edu.

PMID: 37389495
DOI: 10.1016/j.jhsa.2023.05.007

Abstract

Purpose: Traumatic brachial plexus injuries (BPI) are devastating, time-sensitive conditions that often require definitive treatment at academic tertiary care centers. Delays to presentation and surgery have been associated with inferior outcomes. In this study, we evaluate referral patterns associated with delayed presentation and late surgery in traumatic BPI patients.

Methods: Patients diagnosed with a traumatic BPI at our institution from 2000 to 2020 were identified. Medical charts were reviewed for demographic characteristics, prereferral work-up, and referring provider characteristics. Delayed presentation was defined as greater than 3 months from date of injury to initial evaluation by our brachial plexus specialists. Late surgery was defined as greater than 6 months from date of injury. Multivariable logistic regression was used to identify factors associated with delayed presentation or surgery.

Results: A total of 99 patients were included, 71 of whom underwent surgery. Sixty-two patients presented delayed (62.6%), with 26 receiving late surgery (36.6%). There were similar rates of delayed presentation or late surgery by referring provider specialty. Patients whose initial diagnostic EMG was ordered by the referring provider prior to initial presentation at our institution were more likely to have a delayed presentation (76.2% vs 31.3%) and undergo late surgery (44.9% vs 10.0%).

Conclusions: Delayed presentation and late surgery in traumatic BPI patients were associated with initial diagnostic EMG ordered by the referring provider.

Clinical relevance: Delayed presentation and surgery have been associated with inferior outcomes in traumatic BPI patients. We recommend that providers direct patients with clinical concern of traumatic BPI directly to a brachial plexus center without further work-up before referral and encourage referral centers to accept these patients.

Keywords: Brachial plexus; delay; injury; referral; trauma.