Trends in Upper Extremity Injuries Presenting to US Emergency Departments

Background: The purpose of this study was to identify the incidence of upper extremity injuries presenting to emergency departments (EDs) nationally. Methods: The Nationwide Emergency Department Sample (NEDS) database was queried using International Classification of Diseases, Ninth Revision (ICD-9) codes specific for hand/wrist injuries to identify national estimates of ED visits. The incidence, mean age, gender, payer mix, hospital type, location (metropolitan vs nonmetropolitan), and geographic region were recorded. Results: In total, 2 791 257 patients with upper extremity injuries and infections were treated at an ED in 2010. In total, 7.4% resulted in hospital admission; 57% of patients were male. Most common age group affected was 18 to 44 years (44%), followed by those less than 17 years (24%) and 45 to 64 years (21%). The 3 most common injury classifications were soft tissue contusions (37%), fractures (27%), and infections (17%). Thirty-seven percent of patients had private insurance, 21% had Medicaid, 19% were uninsured, 13% Medicare, and 10% other. In total, 63% of visits were seen in nonteaching EDs, 80% were seen in metropolitan cities, and 65% of visits were seen at non–trauma-designated hospitals. Geographically, 37% of visits were in the South, 25% Midwest, 20% Northeast, and 18% in the West. Conclusions: Soft tissue contusion was the most frequent diagnosis. More than half of the patients were male, while the majority of patients were under the age of 44. Ninety-three percent of patients did not require hospital admission. Half had private insurance and the two-thirds of these patients were seen at nonteaching facilities