Hand in Hand – The Activity of a Soft Tissue Trauma Clinic in a Tertiary Referral Centre and its Association with Economic Prosperity

C McQuade, CS Quinlan, OP Shelley, PA Eadie

Sir,

Recent attention on reconfiguration of trauma services nationally has brought to the fore the importance of soft tissue injury management and the infrastructure of plastic surgical services nationwide. As Ireland’s economy emerges from recession and our workforce witnesses increasing opportunities in manual labour and construction sectors, we anticipate an ongoing need to provide tertiary services for soft tissue trauma.

An adult soft tissue trauma clinic was established at our institution in 1999. We analysed recent activity at the clinic and compared our findings with three discrete 6-month periods in 2000-2001, 2002-2003 & 2006-20071.

We aimed to correlate clinic activity with economic events in Ireland to assess if employment levels and prevalence of manual labour are indicative of levels of soft tissue trauma seen at a tertiary centre, and in particular hand trauma.

Our economy grew rapidly from the mid-1990s through to the turn of the century. The construction industry has been cited as one of the main drivers for economic growth in the early 2000s, with high levels of employment in that sector2. Ireland’s Gross Domestic Product (GDP) decreased dramatically in 20082 and there was a reduction in the number of persons employed in construction and industry between 2006  and 20143,4. Workplace related injuries in Ireland peaked in 2007, but figures have since declined4.

Patients attending the trauma clinic from October 2013 to March 2014, inclusive, were identified from the prospectively maintained clinic logbook. The nature of their injury was recorded and a retrospective chart review was performed to determine baseline patient demographics including age, gender and employment status. Using GDP as a surrogate marker of economic status, its correlation with clinic attendance levels was sought using Spearman’s Rank Correlation Co-efficient.

Between September 2013 and March 2014 inclusive, 646 patients attended the clinic. The median patient age was 38. The majority of patients were male. Seventy-eight patients were foreign nationals. Although our records for employment status were incomplete, we could confirm gainful employment in at least 330 patients. Hand trauma remained the commonest reason for referral to the trauma clinic, accounting for more than 73% of all patient referrals.

These figures differ from when the clinic was last audited, in 2006/7, during which we saw a peak attendance of 829 patients over a 6-month period. This coincided with the most economically prosperous period in Ireland since the turn of the century.  During that time hand and upper limb trauma accounted for 98% of clinic referrals.

Of the 4 time periods during which the trauma clinic has been previously audited, GDP peaked in 20062 to a level of €177.7 billion. There was a statistically significant correlation between the state of the economy and the number of patients attending our clinic, resulting in a Spearman’s Rank Correlation co-efficient of 0.8.

Given that our findings confirm that the level of activity of our clinic is at least partially indicative of economic prosperity, we suggest that this association may facilitate future service provision and resource allocation for soft tissue trauma in Ireland.

Correspondence: Christine S. Quinlan, Department of Plastic and Reconstructive Surgery, St James’s Hospital, James’s Street, Dublin 8

Email: christinequinlan@rcsi.ie

References:

  1. Murphy SM, Whately K, Eadie PA, Orr DJ. Unnecessary inter-hospital referral of minor hand injuries: a continuing problem. Ir J Med Sci. 2010;179(1):123-5.
  2. The Irish Economy in Perspective. The Department of Finance. 2012;Dublin, Ireland
  3. Summary of Workplace Injury, Illness and Fatality Statistics 2010-2011. Health and Safety Authority. 2012;Dublin, Ireland.
  4. Summary of Workplace Injury, Illness and Fatality Statistics 2013 – 2014. Health and Safety Authority 2015;Dublin, Ireland.

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