The Utility of Using a Hand Clerking Sheet

for Initial Assessment of Hand Related

InjuriesDr Benjamin Ding

Dr Vaikunthan RajaratnamKhoo Teck Puat Hospital

•Even experienced surgeons miss injuries•Significant implications

Background

Hey HW, S. C. (2010). Hand Injuries seen at an emergency department in Singapore. Eur J Emerg Med, 17(6):343-5.

•To develop a hand clerking sheet •To evaluate•Clinical merit•Practicality•Utility

Objectives

•More accurate documentation •In concordance with intra-operative findings

Hypothesis

van Not HP, F. P. (1997 Mar 1). The value of a hand injury chart . Ned Tijdschr Geneeskd, 141(9):419-22.

•100 consecutive patients, 1 year period•Tertiary care institute •Hand related injuries•Requiring surgical intervention

Inclusion Criteria

•Retrospective evaluation of assessments without clerking notes•Hand clerking sheet for all newly admitted cases•Compared to intra-operative findings

Materials and Methods

 Total 

Number of Injuries(mean)

Documented Preoperatively(mean)

Not Documented(mean)

Accuracy (%) 

All Injuries Diagnosed

 With Hand Clerking 

Sheet (n=50)

160(3.20)

146(2.92)

14(0.28)

91 (p < 0.05)

40(p < 0.05)

 Without Hand Clerking 

Sheet (n=50)

157 (3.14)

96(1.92)

61(1.22)

61 (p < 0.05)

26(p < 0.05)

Results

Mean n

umbe

r of in

juries

per p

atien

t in bo

th arm

s*

Mean n

umbe

r of in

juries

docum

ented

with cle

rking

sheet*

00.5

11.5

22.5

33.5

No clerkingClerking Sheet

1.92

Results

3.14 3.202.92

Number of Injuries Number of Patients

0

20

40

60

80

100

120

140

160

Without Clerking Sheet

Found intra-operatively Correctly diagnosed pre-op

Results

61%

52%

Number of Injuries Number of Patients

0

20

40

60

80

100

120

140

160

With Clerking Sheet

Found intra-operatively Correctly diagnosed pre-op

Results

80%

91%

•Diagnostic rate 61% vs 91%•Studies of ED physicians (54-68%)•Studies of hand surgeons (68-94%)•Increase in diagnostic accuracy

Discussion

J. Patel, R. C. (1998). Hand lacerations, an audit of clinical examination. J Hand Surg Eur Vol, 23:4(482-484).Nassab R, K. K. (2007 Apr). The diagnostic accuracy of clinical examination in hand lacerations. Int J Surg , 5(2):105-8.

•Fear of audit •Only admitted patients •Outpatient clinic setting•Future prospective studies

Limitations

•Thorough and extensive framework•Accurate and uniform description of injuries•Simple and readily implemented

Utility of Study

Thank you