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The Utility of Using a Hand Clerking Sheet
for Initial Assessment of Hand Related
InjuriesDr Benjamin Ding
Dr Vaikunthan RajaratnamKhoo Teck Puat Hospital
•Even experienced surgeons miss injuries•Significant implications
Background
Hey HW, S. C. (2010). Hand Injuries seen at an emergency department in Singapore. Eur J Emerg Med, 17(6):343-5.
•To develop a hand clerking sheet •To evaluate•Clinical merit•Practicality•Utility
Objectives
•More accurate documentation •In concordance with intra-operative findings
Hypothesis
van Not HP, F. P. (1997 Mar 1). The value of a hand injury chart . Ned Tijdschr Geneeskd, 141(9):419-22.
•100 consecutive patients, 1 year period•Tertiary care institute •Hand related injuries•Requiring surgical intervention
Inclusion Criteria
•Retrospective evaluation of assessments without clerking notes•Hand clerking sheet for all newly admitted cases•Compared to intra-operative findings
Materials and Methods
Total
Number of Injuries(mean)
Documented Preoperatively(mean)
Not Documented(mean)
Accuracy (%)
All Injuries Diagnosed
With Hand Clerking
Sheet (n=50)
160(3.20)
146(2.92)
14(0.28)
91 (p < 0.05)
40(p < 0.05)
Without Hand Clerking
Sheet (n=50)
157 (3.14)
96(1.92)
61(1.22)
61 (p < 0.05)
26(p < 0.05)
Results
Mean n
umbe
r of in
juries
per p
atien
t in bo
th arm
s*
Mean n
umbe
r of in
juries
docum
ented
with cle
rking
sheet*
00.5
11.5
22.5
33.5
No clerkingClerking Sheet
1.92
Results
3.14 3.202.92
Number of Injuries Number of Patients
0
20
40
60
80
100
120
140
160
Without Clerking Sheet
Found intra-operatively Correctly diagnosed pre-op
Results
61%
52%
Number of Injuries Number of Patients
0
20
40
60
80
100
120
140
160
With Clerking Sheet
Found intra-operatively Correctly diagnosed pre-op
Results
80%
91%
•Diagnostic rate 61% vs 91%•Studies of ED physicians (54-68%)•Studies of hand surgeons (68-94%)•Increase in diagnostic accuracy
Discussion
J. Patel, R. C. (1998). Hand lacerations, an audit of clinical examination. J Hand Surg Eur Vol, 23:4(482-484).Nassab R, K. K. (2007 Apr). The diagnostic accuracy of clinical examination in hand lacerations. Int J Surg , 5(2):105-8.
•Fear of audit •Only admitted patients •Outpatient clinic setting•Future prospective studies
Limitations
•Thorough and extensive framework•Accurate and uniform description of injuries•Simple and readily implemented
Utility of Study
Thank you