title: Costs and outcome for serious hand and arm injuries during the first year after trauma - a prospective study.
abstract: BACKGROUND
  To study costs and outcome for serious hand and arm injuries during the first year after the trauma.
  
  
  METHODS
  In patients with a Hand Injury Severity Score (HISS) > 50, DASH and EQ-5D scores as well as factors related to costs within the health care sector, costs due to lost production and total costs were evaluated. Cox-regression analysis stratifying for mechanism of injury was used to analyse return to work.
  
  
  RESULTS
  The majority of the 45 included patients (median 42 years 16-64) were men with severe (n = 9) or major (n = 36) injuries with different type of injuries (amputations n = 13; complex injuries n = 18; major nerve injuries/full house n = 13; burn injury n = 1). DASH and EQ-5D decreased and increased, respectively, significantly over time during one year. Total costs (+34%) and costs of lost production were highest for persons injured at work. Factors associated with higher health care costs were age >50 years (+52%), injury at work (+40%) and partial labour market activity (+66%). Costs of lost production had a significant role in total costs of injury. Patients with major injuries had longer duration of sick leave. Patients with severe injuries were more likely to return to work [(RR 3.76 (95% CI 1.38-10.22) from Cox regression, controlling for age, gender and presence of nerve injury].
  
  
  CONCLUSIONS
  Despite the fact that work environments have constantly improved over the last decades, we found that hand injuries at work were most costly both in terms of health care and costs of lost production, although the severity, i.e. HISS, did not differ from injuries occurring at home or during leisure.
authors.affiliation: Department of Hand Surgery, Skåne University Hospital, Malmö, S-205 02, Sweden.
authors.forename: Hans-Eric
authors.initials: HE
authors.lastname: Rosberg
authors.forename: Katarina Steen
authors.initials: KS
authors.lastname: Carlsson
authors.forename: Ragnhild I
authors.initials: RI
authors.lastname: Cederlund
authors.forename: Eva
authors.initials: E
authors.lastname: Ramel
authors.forename: Lars B
authors.initials: LB
authors.lastname: Dahlin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D004185:Disability Evaluation; D005260:Female; D006230:Hand Injuries / Q000191:economics* / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000191:economics* / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016272:Occupational Health / Q000191:economics*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013548:Sweden; D020196:Trauma, Nervous System / Q000191:economics / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult