Emergency medicine task shifting: Quick dash outcome scores of upper extremity injury management

Abstract

This is a pilot study using the Quick DASH Survey (disabilities of arm, shoulder and hand), a validated outcome measurement tool. Our primary objective was to assess functional outcomes of patients with acute upper extremity injuries who were cared for by non-physician clinicians as part of a task-shifting program. Secondarily, we determined if the Quick DASH can be successfully utilized in a non-traditional low-resourced setting. Methods: This pilot was administered by the Global Emergency Care Collaborative (GECC) at the Karoli Lwanga Hospital Emergency Department (ED) in Uganda. Patients were identified retrospectively by querying the ED quality assurance database. An initial list of all patients who sustained traumatic injury (RTA, Assault or Accident) between March 2012 and February 2013 was narrowed to patients with upper extremity trauma, those 18 yrs and older, and those with cellular phone access. This subset of patients was called and administered the Quick DASH. The results were subsequently analyzed using the standardized DASH metrics. These outcome measures were further analysed based upon injury type (simple laceration, complex laceration, fracture, subluxation), laceration location (finger, palm, wrist), age at presentation (18–69), and time from initial presentation to follow up (1–11 months). Results and conclusions: There were a total of 25 initial candidates, of which only 17 were able to complete the survey. Using the Quick DASH Outcome Measure, our 17 patients had a mean score of 29.5 (range 5.0– 56.8). When compared to the standardized Quick DASH outcomes (no work limitation at 27.5 vs. work limited by injury at 52.6) the non-physician clinicians appear to be performing upper extremity repairs with good outcomes. The key variable to successful repair was the initial injury type. Although accommodations needed to be made to the standard Quick DASH protocol, the tool appears to be usable in non-traditional settings.