Predicting Functional Recovery and Return to Work After Mutilating Hand Injuries: Usefulness of Campbell's Hand Injury Severity Score

Purpose We investigated the effect of severity and form of mutilating hand injuries on functional recovery and return to work, and the usefulness of an injury-severity score in predicting these outcomes. Methods We reexamined patients in whom finger amputation or near amputation had been treated with replantation or revascularization at our institution at least 3 years earlier. We evaluated radiographs, sensory recovery, finger range of motion, skin temperature, and 9 C current overall hand function to calculate Tamai and Quick Disabilities of the Arm, Shoulder, and Hand scores, and recorded return-to-work status, duration of treatment, and time away from work. We determined injury level, number of involved fingers, type of injury, and Campbell's Hand Injury Severity score (HISS) from the medical record. Results The average age of the 50 enrolled patients was 43 years (range, 18-69 years); average follow-up was 7.8 years (range, 3.1-15.3 years). More proximal injuries, more involved fingers, and more complicated injury predicted poorer functional recovery. HISS was highly correlated with Tamai's score (r = -0.77; p<.001) and moderately correlated with the Quick Disabilities of the Arm, Shoulder, and Hand score (r = 0.39; p = .009). HISS was only moderately correlated with length of treatment (r = 0.32; p<.05) and with time away from work (r = 0.34; p<.05). Mean HISS among, the 3 return-to-work groups differed remarkably. When HISS was <50, 11 of 12 patients returned to their original jobs; when it was between 50 and 150, 17 of 23 patients were able to return; and when it was >150, only 4 of 15 were able to return to work. Conclusions Given the current surgical care of patients with mutilated hand injuries, HISS determined at the time of injury can adequately predict functional outcome and return to work status. Larger studies will be necessary to validate these findings. (J Hand Surg 2009;34A:880-885. (C) 2009 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.) Type of study/level of evidence Prognostic III.