Emergency Room High Index of Suspicion in Apparently Innocent Wounds Can Encounter Missed Tendon Injuries.
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Date
2015
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Abstract
Introduction: Limb injuries by sharp objects commonly result in tendon or neurovascular damage.
The aim of this study is (1) to determine the incidence of significant neurological,
musculotendinous or vascular injury; (2) to explore the cause of such wounds; (3) to determine the
incidence of missed injuries; and (4) to assess the prognosis of neurological, vascular and
musculotendinous injuries.
Methods: Fifty eight adult patients were evaluated in the Emergency Department of our institution
for incised wounds sustained to upper and lower extremities. Major trauma with obvious musculotendinous, vascular and neurological injuries was excluded. An injury was characterized
as being missed if a patient had received inappropriate treatment or had returned due to persistent
symptoms despite being examined, treated and discharged. Only wounds of less than 24 hours
duration were included. Non-accidental injuries were excluded.
Results: Fifty one (89%) patients sustained upper extremity wounds while only seven (11%)
sustained injuries to the lower limb. Neurovascular and tendon injuries occurred exclusively in the
upper limb. Twenty one (36%) patients sustained tendon, nerve and/or vascular injuries (41.2%).
Glass injury was found to be the most common cause (41.3%) followed by Knife injuries (15.5%).
Fifteen patients were offered an admission to hospital by the Trauma service for definitive
treatment. Four of these patients signed DAMA (Discharge against Medical Advice). Six patients
did not warrant admission and were discharged from the Emergency Department following
appropriate treatment. Thirty seven patients were treated by Emergency Physicians and
subsequently discharged. A missed tendon injury was reported in one patient (1.7%).
Conclusion: A thorough clinical examination and accurate injury documentation in the Emergency
Department is fundamental in recognizing tendon injuries.
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Keywords
Sharp objects, emergency room, limb injuries, tendon injuries, neurovascular injuries
Citation
Khan Zafar Mahmood, Nasim Bina, Yadgir Tanvir, Skaf Omer Al, Sajjad Ahmed, Ali Zulfiqar, Naroo G Y. Emergency Room High Index of Suspicion in Apparently Innocent Wounds Can Encounter Missed Tendon Injuries. British Journal of Medicine and Medical Research. 2015; 8(11): 956-962.