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

Tapp, Marion BS*; Wenzinger, Eric MD; Tarabishy, Sami MD*; Ricci, Jerec MD; Herrera, Fernando A. MD*,‡,§

doi: 10.1097/SAP.0000000000002083
Peripheral Nerve Surgery and Research
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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.

From the *Division of Plastic Surgery, Medical University of South Carolina, Charleston, SC

Division of Plastic Surgery, Harvard Medical School, Boston, MA

Department of Surgery, Medical University of South Carolina

§Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC.

Received March 15, 2019, and accepted for publication, after revision July 21, 2019.

Conflicts of interest and sources of funding: none declared.

Presented at the Plastic Surgery the Meeting (ASPS) 2018 in Chicago, IL (podium presentation), September 29, 2018.

Reprints: Fernando A. Herrera, MD, Division of Plastic and Reconstructive Surgery, Medical University of South Carolina, CSB 404, 96 Jonathan Lucas St, Charleston, SC 29466. E-mail: herreraf@musc.edu.

Online date: November 4, 2019

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