This document describes a study evaluating the utility of using a hand clerking sheet for initial assessment of hand injuries. The study compared assessments of 100 patients with hand injuries who were assessed with the clerking sheet to assessments of 100 patients without the sheet. Results showed assessments using the clerking sheet had significantly higher accuracy, with 91% of injuries correctly documented preoperatively compared to 61% without the sheet. The clerking sheet provided a thorough and extensive framework for assessments, leading to more accurate and uniform documentation of hand injuries.

1. The Utility of Using a Hand
Clerking Sheet for Initial
Assessment of Hand Related
Injuries
Dr Benjamin Ding
Dr Vaikunthan Rajaratnam
Khoo Teck Puat Hospital

2. •Even experienced
surgeons miss
injuries
•Significant
implications
Background
Hey HW, S. C. (2010). Hand Injuries seen at an emergency department in Singapore. Eur J Emerg Med, 17(6):343-5.

3. •To develop a
hand clerking
sheet
•To evaluate
•Clinical merit
•Practicality
•Utility
Objectives

4. •More accurate
documentation
•In concordance
with intra-
operative
findings
Hypothesis
van Not HP, F. P. (1997 Mar 1). The value of a hand injury chart . Ned Tijdschr Geneeskd, 141(9):419-22.

5. •100 consecutive
patients, 1 year
period
•Tertiary care
institute
•Hand related
injuries
•Requiring surgical
intervention
Inclusion Criteria

6. •Retrospective evaluation of
assessments without clerking notes
•Hand clerking sheet for all newly
admitted cases
•Compared to intra-operative
findings
Materials and Methods

8. Total
Number of
Injuries
(mean)
Documented
Preoperatively
(mean)
Not
Documented
(mean)
Accuracy
(%)
All Injuries
Diagnosed
With Hand
Clerking
Sheet (n=50)
160
(3.20)
146
(2.92)
14
(0.28)
91
(p < 0.05)
40
(p < 0.05)
Without
Hand
Clerking
Sheet (n=50)
157
(3.14)
96
(1.92)
61
(1.22)
61
(p < 0.05)
26
(p < 0.05)
Results

9. 0
0.5
1
1.5
2
2.5
3
3.5
Mean number of injuries per patient in both arms* Mean number of injuries documented with clerking
sheet*
No clerking
Clerking Sheet
1.92
Results
3.14 3.20
2.92

10. 0
20
40
60
80
100
120
140
160
Number of Injuries
Number of Patients
Without Clerking Sheet
Found intra-operatively
Correctly diagnosed pre-op
Results
61%
52%

11. 0
20
40
60
80
100
120
140
160
Number of Injuries
Number of Patients
With Clerking Sheet
Found intra-operatively
Correctly diagnosed pre-op
Results
80%
91%

12. •Diagnostic rate 61% vs 91%
•Studies of ED physicians (54-68%)
•Studies of hand surgeons (68-94%)
•Increase in diagnostic accuracy
Discussion
J. Patel, R. C. (1998). Hand lacerations, an audit of clinical examination. J Hand Surg Eur Vol, 23:4(482-484).
Nassab R, K. K. (2007 Apr). The diagnostic accuracy of clinical examination in hand lacerations. Int J Surg , 5(2):105-8.

13. •Fear of audit
•Only admitted patients
•Outpatient clinic setting
•Future prospective studies
Limitations

14. •Thorough and
extensive
framework
•Accurate and
uniform
description of
injuries
•Simple and readily
implemented
Utility of Study

15. Thank you