Could an 'ankle hotline' relieve strain on health care demands?

Should lower leg strains and sprains take up valuable ER time and resources? According to a new study by Kaj Lambers and colleagues, from Massachusetts General Hospital in Boston, USA, strains and sprains account for over a third of lower extremity injuries treated at emergency departments. They reason that because these problems are not life-threatening, perhaps telephone triage and scheduled care appointments might be a better use of precious emergency healthcare resources. The work is published online in Clinical Orthopaedics and Related Research published by Springer.

In order to prevent injuries, allocate resources more efficiently, and prioritize training, it is important to get an accurate picture of the number of patients and types of injuries presenting to emergency departments. Lambers and colleagues looked specifically at leg problems that bring patients to the ER.

They analyzed data from the National Electronic Injury Surveillance System (NEISS) for 119,815 patients with lower extremity injuries in 2009. They wanted to determine the number of leg injuries by region and disease category, patients' age, circumstances of the injury, and where it occurred. They also looked at year-to-year consistency between 2000 and 2009 to get a picture of injury trends.

They found that strains and sprains accounted for 36 percent of all lower extremity injuries, the most common of which was an ankle sprain - an injury most common in young adults and teenagers. Indeed, younger patients were more likely to have , foot contusions/abrasions, and foot strains/sprains. Older patients were more likely to have lower trunk (femoral neck, hip, pelvis, and lumbar vertebrae) fractures and lower trunk contusions/abrasions.

The authors conclude: "Relatively low-severity lower extremity problems such as strains and sprains account for a substantial number of emergency department visits. Different approaches to triage and evaluation of lower extremity might result in better utilization of emergency healthcare resources. For instance, with ankle injuries might call an emergency phone number to be triaged for an urgent visit if necessary, or a scheduled visit during regular business hours instead."

More information: Lambers K et al (2011). Incidence of patients with lower extremity injuries presenting to US emergency departments by anatomic region, disease category and age. Clinical Orthopaedics and Related Research. DOI 10.1007/s11999-011-1982-z

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