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An Analysis of Patients with False Negative Upper Extremity Nerve Exam who Require Operative Nerve Repair
Vanessa Leonhard, B.S.
Scott N Loewenstein, M.D.
Sarah Sasor, M.D.
Julia Cook, M.D.
Joshua Adkinson, M.D.
Indiana University Plastic Surgery Residency Program
2018-01-31
Presenter: Scott N Loewenstein
Affidavit:
All of the work on this project represents original work of the Authors.
Director Name: William Wooden
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background:
Many patients with complete nerve lacerations have intact sensory examinations at the time of initial evaluation. The purpose of this study was to identify clinical characteristics and patient-related factors that predict false negative sensory examinations in the upper extremity.
Methods:
We identified patients who underwent upper extremity nerve repair based on Current Procedural Terminology codes from 2013-2017 at a single level one trauma center. Charts were reviewed for initial sensory examination findings and the specialty of the examining physician. Data were also collected regarding mechanism of injury, concurrent trauma, Glasgow Coma Score (GCS), blood alcohol level, and urine drug screen at initial evaluation.
Results:
Sixty-two patients with complete upper extremity nerve lacerations were identified during the study period. Of these, 13 (21%) had a normal preoperative sensory examination documented by the initial provider (emergency room or primary care physician), whereas hand surgeons documented normal findings in 8 patients (13%). Hand surgeons were more likely to correctly identify nerve injuries at initial patient presentation when compared to other initial providers (73% vs. 48%; p<0.05). No statistically significant differences in the likelihood for a false negative examination were found when comparing laterality, level of injury, mechanism, concurrent trauma, GCS score, blood alcohol level, or positive urine drug screen.
Conclusions:
Hand surgeons are more likely to correctly identify upper extremity peripheral nerve injuries on initial examination compared to other providers. This highlights the importance of prompt specialist referral when the possibility of an upper extremity nerve injury exists.
