581 Documentation of Peripheral Sensory Function Assessment in Hand Trauma at a Regional Referral Unit

Abstract

Abstract Aim This audit aimed to assess the quality of documentation of sensory function assessment in hand trauma patients treated at a regional referral unit. The audit was based on The British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) “Peripheral Nerve Injury” national guideline, last updated in December 2021. Method The scope included all hand trauma referrals received between the 1st and 10th of March 2022. Initial case screening excluded missed appointments, telephone consultations, missing hand assessment sheets and reviews of old injuries. Following that, patients with diagnoses of pulp injury, amputation, closed central slip injury, mallet injury, phalanx infection, old injuries, and removal of metalwork, which were not relevant to the audited guideline, were excluded. All remaining records were analysed for any description of sensory assessment and description of the sensation level using a 1-10 scale. Additionally, cases of volar lacerations were checked for documentation of two-point discrimination (2PD). Results The search yielded 97 patient records. Following the initial screening, 10 cases were excluded. 56 out of 87 remaining cases had diagnoses relevant to the audit. 24 cases were classified as volar injuries. 73% of hand assessment sheets contained any description of peripheral sensory assessment (41/56). 1-10 assessment was documented on 23% of records (13/56). 17% of volar injury records contained 2PD examination documentation (4/24). Conclusions Documentation of sensory assessment in hand trauma, especially two-point discrimination in volar lacerations, requires improvement. One possibility to improve the adoption of 2PD evaluation would be an introduction of a cheap and widely available assessment device.