gms | German Medical Science

Objectives/Interrogation: Diagnosis of the injured hand tests anatomical knowledge, examination skills and bedside manner. An accurate examination is crucial for good management of patient expectations and efficiency in planning theatre. The majority of hand assessments are undertaken by juniors, without the benefit of clinical experience.

The aim of this retrospective audit was to identify areas where juniors require more support to improve their examination of the injured hand, by assessing the accuracy of the hand examination in our unit.

Methods: The first two hundred hand operations performed in August were collected electronically. Duplicates and elective cases excluded, and the 187 remaining cases underwent an electronic notes review. Operative findings were compared to documented examination findings of the hand team. An assessment of accuracy was made, and missed diagnoses and over diagnoses recorded.

Results and Conclusions: Pathologies were grouped into categories of structural damage (82), fingertip and nailbed injuries (33), fractures (35) and infection (4). The most commonly inaccurate group was structural damage with 62.2% of examinations incorrect. The most commonly missed diagnoses were extensor tendon injuries (38.9% of true injuries missed) and nerve injuries (38.5% of true injuries missed). The most commonly overdiagnosed were nerve injuries (28 instances of overdiagnosis). Sensitivity of hand examination was 67.5%, and specificity 11.6%.

Assessing the performance of a test allows the user to better understand a test result, and identifies areas for improvement. This audit has allowed us to identify commonly made mistakes, and to create a targeted hand curriculum for future teaching.