title: Predictive value of psychological screening in acute hand injuries.
abstract: Difficulties in adjustment frequently accompany severe hand injuries. The purpose of this study was to determine whether presurgical screening could predict long-term adjustment problems. One hundred thirteen patients with severe hand injuries completed a presurgical questionnaire evaluating flashbacks, avoidance, and causal factors pertaining to the injury. Patients were evaluated by a psychologist within 5 days after surgery and again 6 months later. Flashbacks initially occurred with equal frequency in occupationally and nonoccupationally injured groups. At 6-month follow-up 50% of the occupationally injured patients and 25% of the nonoccupationally injured patients had flashbacks. Avoidance of the activity at which patients were injured was also assessed. Among occupationally injured patients, 52% initially reported no avoidance compared with 17% at follow-up. Patients with nonoccupational injuries showed more initial avoidance (68%), with slightly less at follow-up (61%). Of the occupationally injured patients, 46% initially reported personal error or fatigue as the cause of their injury, but only 6% reported this as the cause at follow-up; it is interesting that at 6-month follow-up 81% of this group reported machine failure or lack of safeguards. Among nonoccupationally injured patients, 71% reported personal error as the cause of injury presurgically and 66% at 6-month follow-up. Presurgical screening appears to be a valid means of identifying persons at risk of ongoing adjustment problems after hand injury. A screening interview can easily be conducted in less than 5 minutes.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee 53226.
authors.forename: B K
authors.initials: BK
authors.lastname: Grunert
authors.forename: S W
authors.initials: SW
authors.lastname: Hargarten
authors.forename: H S
authors.initials: HS
authors.lastname: Matloub
authors.forename: J R
authors.initials: JR
authors.lastname: Sanger
authors.forename: D P
authors.initials: DP
authors.lastname: Hanel
authors.forename: N J
authors.initials: NJ
authors.lastname: Yousif
mesh_terms: D000062:Accidents, Occupational; D000208:Acute Disease; D001362:Avoidance Learning; D005260:Female; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000209:etiology / Q000523:psychology* / Q000601:surgery; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011300:Preoperative Care