社会贫困对肘管综合征治疗时间表的影响

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2024-11-01 DOI:10.1016/j.jhsg.2024.08.019

Akhil Dondapati MD , Janet Ngoc Tran BA , Callista Zaronias BA , Cody C. Fowler MD , Thomas J. Carroll MD , Bilal Mahmood MD

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引用次数: 0

摘要

目的本研究旨在确定地区贫困指数（ADI）对肘管综合征（CuTS）患者治疗时间的影响。我们假设，社会贫困程度的增加将与从发病到手术的护理里程碑之间的时间增加相关。方法这是一项回顾性研究，研究对象是在一家学术机构接受手术治疗的确诊 CuTS 患者。获得的变量包括年龄、性别、体重指数、ADI、电诊断（EDX）严重程度分类以及治疗里程碑之间的时间间隔。治疗里程碑包括从初次就诊到接受手外科手术、EDX检查和手术之间的时间间隔。分析包括单变量χ2检验和方差分析，以及多变量线性回归和逻辑回归。单变量分析发现，不同 ADI 百分位数的护理时间没有差异。多变量分析显示，ADI越高，预示从发病到手术的时间越长，但这一趋势并不明显。中度 EDX 评级与从发病到手术的时间延长相关。轻度 EDX 评级与从 EDX 研究到手术的时间延长相关。年龄是最初发病到手术以及 EDX 到手术之间时间缩短的重要预测因素。结论社会贫困与 CuTS 治疗时间的延迟无明显相关性。年龄的增加与治疗时间的缩短明显相关，这可能反映了医生对不同年龄患者的治疗方法存在差异。初次就诊前进行的电诊断测试可加快手部诊所的治疗速度。然而，这可能反映了治疗的整体延迟（如果从转诊到就诊的延迟导致了电诊断检查的获得），也可能反映了真正的加速治疗。

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Impact of Social Deprivation on Cubital Tunnel Syndrome Treatment Timeline

Purpose

The purpose of this study was to establish the impact of area deprivation index (ADI) on treatment timelines of patients with cubital tunnel syndrome (CuTS). We hypothesize that increased social deprivation will correlate with increased time between care milestones from presentation to surgery.

Methods

This is a retrospective study of patients diagnosed with CuTS who underwent surgical intervention at a single academic institution. Variables including age, sex, body mass index, ADI, electrodiagnostic (EDX) severity classification, and time elapsed between treatment milestones were obtained. Treatment milestones included time elapsed between initial presentation to hand surgery and EDX studies, and surgery. Analysis included univariate χ² tests and analysis of variance, as well as multivariate linear and logistic regressions.

Results

Six hundred and fifty-three patients were divided by ADI national percentiles from the least to most deprived tertiles. Univariate analysis found no differences in care timelines across ADI tertiles. Multivariate analysis revealed a nonsignificant trend toward higher ADI predicting longer time from presentation to surgery. Moderate EDX rating correlated with increased time from presentation to surgery. Mild EDX ratings correlate with increased time from EDX studies to surgery. Age was a significant predictor of decreased time between initial presentation and surgery and between EDX and surgery. Completion of EDX studies prior to presentation significantly decreased time to surgery.

Conclusions

Social deprivation does not significantly correlate with delays in the treatment timeline for CuTS. Increased age was significantly correlated with shorter treatment timelines, which may reflect differences in physicians’ approaches to patients of different ages. Electrodiagnostic testing obtained prior to initial presentation expedited care following presentation to hand clinic. However, this could reflect either an overall delay in care (if EDX were obtained because of a delay from referral to presentation) or truly expedited care.