title: Systematic review: Predicting adverse psychological outcomes after hand trauma.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  After traumatic hand injury, extensive physical and psychological adaptation is required following surgical reconstruction. Recovery from injury can understandably be emotionally challenging, which may result in impaired quality of life and delayed physical recovery. However, the evidence base for identifying high-risk patients is limited.
  
  
  METHODS
  A PROSPERO-registered literature search of MEDLINE (1946-present), EMBASE (1980-present), PsychInfo, and CINAHL electronic databases identified 5156 results for studies reporting psychological outcomes after acute hand trauma. Subsequent review and selection by 2 independent reviewers identified 19 studies for inclusion. These were poor quality level 2 prognostic studies, cross sectional or cohort in design, and varied widely in methodology, sample sizes, diagnostic methods, and cutoff values used to identify psychological symptoms. Data regarding symptoms, predisposing factors, and questionnaires used to identify them were extracted and analyzed.
  
  
  RESULTS
  Patients with amputations or a tendency to catastrophize suffered highest pain ratings. Persisting symptom presence at 3 months was the best predictor of chronicity. Many different questionnaires were used for symptom detection, but none had been specifically validated in a hand trauma population of patients. Few studies assessed the ability of selection tools to predict patients at high risk of developing adverse psychological outcomes.
  
  
  CONCLUSIONS
  Despite a limited evidence base, screening at 3 months may detect post-traumatic stress disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention and improved treatment outcomes.
  
  
  METHODS
  Level 4.
authors.affiliation: Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom. Electronic address: emmaladds@btinternet.com.
authors.forename: Emma
authors.initials: E
authors.lastname: Ladds
authors.affiliation: Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Redgrave
authors.affiliation: Department of Psychological Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotton
authors.affiliation: Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Lamyman
mesh_terms: D002908:Chronic Disease; D005260:Female; D006230:Hand Injuries / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology / Q000523:psychology; D011237:Predictive Value of Tests; D011379:Prognosis; D011594:Psychometrics; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Anxiety; Chronic pain; Depression; Hand trauma; PTSD; Pain; Psychological