Comparison of Time to Surgery by Referring Providers in Traumatic Pan Plexus Injuries

Introduction: Traumatic pan brachial plexus injuries (pBPIs) are devastating injuries that can result in severe functional, psychological, and socioeconomic damage. While guidelines vary depending on mechanism and type of injury, delayed repairs >6 months post-injury are associated with worse functional outcomes and thus early referral for surgical evaluation is crucial to improving long-term recovery In this study, we aim to understand which specialties are referring adult pBPIs for surgical intervention, and if type of specialty is associated with timing of referral.

Methods: This is a retrospective review of adult traumatic pBPI patients underwent brachial plexus reconstruction at a single institution over the past 12 years. ANOVA was used to identify significant correlations between provider type and timing of referral or brachial plexus reconstruction.

Results: 22 patients were included in the study. Average age at presentation was 34 years, patients were predominantly male (86%), and the most common mechanism of injury was motor vehicle accidents (86%). Referring providers by specialty were PM&R (41%), orthopedic surgery (18%) and neurosurgery (18%). Most referrals originated at academic centers (72%). Average time from injury to referral was 3.4 months and average time from injury to surgery was 9.5 months. There was no statistically significant difference between time from injury to referral (p=0.91) or surgery (p=0.82) based on the referring specialty. There was a weak positive correlation between earlier referrals and earlier surgery (R2= 0.223).

Conclusion : PM&R, orthopedic surgery, and neurosurgery were the most common referring specialties for traumatic pan plexus injuries with no differences in referral times based on specialty type. Importantly, time to surgery was >6 months, suggesting possible delay in care for these patients. Earlier referrals have a weak positive correlation with earlier surgery however this is limited by small sample size and variability. These data suggest a barrier to referral that is not unique to specific specialties. Examining the flow of trauma patients from diagnosis to subspecialty referral to surgical repair, identifying opportunities to streamline this process, is an important future direction for this work.