The Epidemiology of Upper Extremity Nerve Injuries and Associated Cost in the US Emergency Departments

Abstract

Background The purpose of our study was to determine the incidence and average cost of nerve injuries in patients presenting with upper extremity trauma. Methods The Nationwide Emergency Department Sample database was queried using International Classification of Diseases, Ninth Revision codes specific to peripheral nerve injuries of the upper extremity. Data on the incidence, patient demographics, average number of associated diagnoses, Injury Severity Scale (ISS) score, mechanism of injury, and average cost of care were collected and analyzed. Results Of 1.58 million upper extremity traumatic injuries, there were 5244 nerve injuries, resulting in an annual incidence of 16.9 per 100,000 persons with an average age of 38.42 years. Ulnar nerve injuries were the most common (3.86 per 100,000) followed by digital nerve (2.96 per 100,000), radial nerve (2.90 per 100,000), and median nerve (2.01 per 100,000). Injuries to the brachial plexus had the highest average ISS score (9.79 ± 0.71) and number of presenting diagnoses (8.85 ± 0.61) while having a lower than average emergency department (ED) cost. Patients with digital nerve injuries had the highest average ED cost ($8931.01 ± $847.03), whereas their ISS score (2.82 ± 0.19) and number of presenting diagnoses (4.92 ± 0.22) were the lowest. The most commonly reported mechanism of injury in this study population was from a laceration (29.2%) followed by blunt injury, fall (14.8%), and being struck (7.20%). Males were 2.14 (2.01–2.28) times more likely to have an injury to an upper extremity nerve and 3.25 (2.79–3.79) times more likely to injure a digital nerve. Conclusions While there was a low incidence of upper extremity nerve injuries associated with upper extremity trauma, the ulnar nerve was most frequently injured. Males were twice as likely to sustain a traumatic upper extremity nerve injury, with laceration being the most common mechanism of injury. The average ED cost associated with upper extremity nerve injuries in the United States was determined to be approximately $5779.

Medial Sural Perforator “Nerve through Flap”: Anatomical Study and Clinical Application

“…MSAP flap was first described in 2001 by Cavadas and Hallok for both extremity and head and neck reconstructions [17,18] and now are widely used with many variations [18,19]. Literature data show that ulnar nerve injury most frequently results in hospital admission, when compared with median and radial nerve injuries and the functional outcome after repair through primary neurorrhaphy or grafting is relatively poor when compared to results after radial or median nerve repair [20]. Distal ulnar nerve lesions in zone 1 cause anesthesia of 4th and 5th fingers, intrinsic muscles impairment with the typical claw-like appearance of the hand [21].…”

Total, Gender- and Age-specific Incidence Rates of Upper Extremity Nerve Injuries in Finland

“…To the authors' knowledge, there are no previous population-based studies of incidence of musculocutaneous or axillary PNIs. An insurance-based study of PNIs in US emergency departments estimated an annual crude incidence for axillary nerve injury at 0.2 per 100,000 and musculocutaneous nerve injury at 0.06 per 100,000 10 . A previous single-hospital study reported 6 (4.9%) iatrogenic musculocutaneous nerve injuries of 122 surgically treated patients 18 .…”

“…Up to 5% of patients with multiple injuries had PNIs in a trauma center in Canada 9 . Tapp et al calculated the annual incidence rate of PNIs as 16.9 per 100,000, and the most commonly affected was the ulnar nerve with an annual crude incidence rate of 3.9 per 100,000 10 . Taylor and colleagues found the highest PNI rates after a crush injury 11 .…”

Magnetic Resonance Neurography for Evaluation of Peripheral Nerves

“…Peripheral nerve injuries (PNIs) are common, with an incidence of 16.9 per 100,000 citizens in the United States. 1 Etiologies include traumatic injury, metabolic disorders, and chronic compression. 1 PNIs, particularly those that are not caused by trauma, are difficult to diagnose given that their presentation varies, and initial symptoms may be vague or misleading.…”