American Society for Peripheral Nerve
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Epidemiology and Risk Factors for Emergency Department (ED) Recidivism Following Peripheral Nerve Injury of the Upper Extremity
Shreya Raman, MD1; Sarah N. Chiang, BS2; Jordan Bruce, MD2; Amy F. Kells, MD, PhD2
1University of Illinois at Chicago, Chicago, IL; 2Washington University School of Medicine in St. Louis, St. Louis, MO

Introduction Upper extremity peripheral nerve injuries are a common presentation to the ED. However, these injuries are rarely treated operatively in the acute setting, as the development of symptoms and serial evaluation occur over months following initial injury. For some patients, disruptive sensory and motor symptoms may cause a return to the ED, resulting in unnecessary imaging and premature diagnostic studies regarding their nerve injury. Therefore, this epidemiological study aims to identify risk factors for ED return following these injuries, using recidivism within 30 days as the primary endpoint.
Methods Patients with suspected peripheral nerve injuries seen in the ED by the plastic surgery service at a large tertiary academic center were retrospectively collected from 2013-2021. Patients included were treated non-operatively in the acute setting, while those who received an emergent operative procedure were excluded. Demographics, medical/psychiatric co-morbidities, mechanism of injury, and physical exam findings were collected and analyzed using chi-square and Mann-Whitney tests for categorical and continuous variables, respectively.
Results 305 patients met inclusion criteria, with a median age of 31 (interquartile range: 22-49). Following their initial ED presentation, the vast majority of patients (96.4%) followed up in clinic, and 25 (8.2%) patients returned to the ED within a month. 72% of early returning patients were males, with no significant difference based on gender (p = 0.64). Substance abuse, Black race, and sensory impairment were predictors for ED return following upper extremity peripheral nerve injury (OR = 7.02 [95% CI 1.60-30.82], p = 0.01; OR = 6.60 [95% CI 2.08-20.95], p = 0.001; OR = 5.85 [95% CI 1.65-20.73], p = 0.006, respectively). Lack of insurance and close proximity to the hospital were also associated with ED return (p = 0.02; p = 0.02). A total of 110 patients (36%) were employed; however, employment status was not associated (p = 0.60). Similarly, medical/psychiatric co-morbidities, suspected nerve injury (ulnar, radial, median, digital, other), and mechanism of injury (sharp, blunt/crush, avulsion, blast injury) were not associated with ED recidivism.
Conclusions In this large, single center retrospective study, sensory impairment, race, and substance abuse were identified as predictors of ED recidivism. These factors should inform the management of patients at their initial ED presentation, with implications for patient education and the optimization of follow up evaluation after upper extremity peripheral nerve injury.


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