Incidence of Nerve Injury After Extremity Trauma in the United States
William M Padovano, MPHS1, Jana Dengler, M.D.1, J. Megan M. Patterson, MD2, Andrew Yee, BS3, Alison K. Snyder-Warwick, MD1, Matthew Wood, PhD1, Amy M Moore, MD3 and Susan E Mackinnon, MD1, (1)Washington University School of Medicine, Saint Louis, MO, (2)Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, (3)Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
Background: Traumatic peripheral nerve injuries cause chronic pain, disability, and long-term reductions in quality of life. Depending on trauma location and severity, 1 to 3% of patients are diagnosed with nerve injuries during the first few months after trauma. However, establishing the long-term prevalence and burden of nerve injuries has proven difficult, as they are often diagnosed months to years after trauma and in a variety of care settings.
Methods: The Truven MarketScan Commercial Claims and Encounters database from 2010 to 2015 was used to identify patients aged 18 to 64 who presented to emergency departments for upper and/or lower extremity traumas in the United States. Cumulative incidences were calculated for nerve injuries diagnosed within two years of trauma. Cox regression models were developed to examine associations between upper extremity nerve injury and chronic pain, disability, and use of physical therapy or occupational therapy.
Results: The final cohort consisted of 1,230,362 patients. By two years after emergency department presentation, nerve injuries were diagnosed in 2.6% of upper extremity traumas and 1.2% of lower extremity traumas. Among patients who required hospitalization for their injuries, nerve injuries were eventually diagnosed in 9.2% of upper extremity traumas and 2.0% of lower extremity traumas. Moreover, only 9% and 38% of nerve injuries were diagnosed by the time of emergency department and hospital discharge, respectively. In general, upper extremity nerve injuries were diagnosed earlier than lower extremity nerve injuries. Nonetheless, 12.2% of brachial plexus injuries and 21.3% of median nerve injuries were identified more than 1 year after extremity trauma. Patients with nerve injuries were more likely to be diagnosed with chronic pain (HR 5.9, 95% CI 4.3 to 8.2), use physical therapy services (HR 10.7, 95% CI 8.8 to 13.1), and use occupational therapy services (HR 19.2, 95% CI 15.4 to 24.0) more than 90 days after injury.
Conclusion: The incidence of nerve injury in this large national cohort was higher than has been previously reported. Despite recent advancements in the treatment of nerve injuries, only a minority were diagnosed by the time of emergency department or hospital discharge. These findings may improve practitioner awareness and inform public health interventions for injury prevention.
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