Evaluating acute hand injuries in the emergency department: a comparison of physicians with varying postgraduate training backgrounds. St Louis Emergency Physicians' Association Research Group.

This study compared the quality of the history, physical examination, and treatment of patients with hand injuries performed by emergency physicians with varied training backgrounds. Four hundred ninety-seven patients with isolated hand injuries were evaluated by 97 physicians, who were classified into four groups: (1) emergency medicine board certified, (2) primary care specialty board certified, (3) non-board certified, and (4) moonlighting residents. The history and physical examination were separated into several variables to define deficiencies. Adequacy of treatment were determined by two emergency physicians and an orthopedic surgeon. Significant differences were found in five categories. Group no. 4 documented the history and followed the Centers for Disease Control tetanus prophylaxis guidelines better than did groups no. 1 or 2. Group no. 1 obtained x-rays less often than any other group and had a better treatment score, but the latter did not reach statistical significance. Physicians of lesser training are more meticulous about documenting a history and following treatment protocols than are residency-trained or boarded emergency physicians, but order more tests and are less likely to document adequate treatment.