title: Association between the initial anatomical severity and opportunity of return to work in occupational hand injured patients.
abstract: BACKGROUND
  The severity of the injury is the most important factor to return to work (RTW) when it comes to hand injuries. The purpose of our study is to examine the relationship between the initial anatomic severity, evaluated by the Hand Injury Severity Scoring (HISS) system, and probability of RTW in occupational hand injured patients.
  
  
  METHODS
  In this retrospective cohort study, 140 patients hospitalized for surgery due to occupational hand injuries between 2004 and 2008 were recruited. Participants were interviewed for occupational history and RTW status. The probability of RTW was compared with the initial HISS scores by multiple logistic regression models.
  
  
  RESULTS
  In workers' compensation group, there was a significant relationship between HISS severity and the probability of RTW. Compensated patients with moderate injuries (odds ratio [OR] = 0.15; 95% confidence interval [CI], 0.03-0.70) and severe injuries (OR = 0.13; 95% CI, 0.02-0.75) were significantly less likely to RTW than those with minor injuries, and those with major injuries were the least likely to RTW (OR = 0.07; 95% CI, 0.01-0.36). However, no association was found between HISS severity and the probability of RTW for patients without workers' compensation. With regard to the HISS components, patients with motor or neural component deficits had a significantly lower opportunity of RTW, with the neural deficits being the most influential.
  
  
  CONCLUSIONS
  HISS is a useful instrument to predict the opportunity of RTW while restricted to the compensated patients. We also verified that the relationship between HISS severity and the probability of RTW existed for groups but not for individual patients.
authors.affiliation: Bureau of Food and Drug Analysis, Department of Health, Executive Yuan, Taipei, Taiwan.
authors.forename: Yung-Yi
authors.initials: YY
authors.lastname: Lee
authors.forename: Jer-Hao
authors.initials: JH
authors.lastname: Chang
authors.forename: Shyh-Jou
authors.initials: SJ
authors.lastname: Shieh
authors.forename: Yao-Chou
authors.initials: YC
authors.lastname: Lee
authors.forename: Li-Chieh
authors.initials: LC
authors.lastname: Kuo
authors.forename: Yungling L
authors.initials: YL
authors.lastname: Lee
mesh_terms: D000062:Accidents, Occupational; D000293:Adolescent; D000328:Adult; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies