Hand Injury Severity Scoring System Research Articles

Epidemiology of complex hand injuries treated in the Plastic Surgery Department of a tertiary referral hospital in Warsaw

BackgroundTrauma to the hand is common and potentially serious, impairing daily living and general quality of life. Patients are often unable to work for several months, with hand function improving only gradually. Here, we review the epidemiology of hand injuries treated at a tertiary referral hospital in Warsaw, Poland.Material and methodsIn this single-centre, retrospective study, we reviewed medical records of patients presenting to the A&E Unit of the Plastic Surgery Department, Centre of Postgraduate Medical Education in Warsaw, Poland, between January 2001 and December 2005. We assessed a number of patient and injury characteristics, including severity, scored with the Hand Injury Severity Scoring System (HISS), and time off work.ResultsOf 1091 patients with a hand injury, 84% were male and over half were under the age of 40 years. Hand injury commonly resulted in tendon damage (56.1%), especially to finger flexors (79%), and in skin loss (37.8%). Amputations occurred in 24.1% of cases, while fractures (9.6%) and nerve (6.1%) or joint (5.5%) damage were less common. HISS-graded injury severity was moderate in 28.6% of cases, over half of the patients suffered severe (25.5%) or major (26.5%) injuries, and minor injuries were relatively uncommon (19.4%).ConclusionsAmongst patients admitted to our Department, the most common injuries were tendon damage, skin loss, and amputations. Over half of the patients presented with severe or major injuries and took six months or longer to return to work, suggesting they were likely to face substantial social and economic consequences of their injury.Level of evidenceIV: retrospective series.

Catastrophic Hand Injuries in Children

Objective: Catastrophic injuries of the hand are devastating and often lead to a significant functional and psychosocial disability. These injuries usually affect most hand structures (skin, soft tissues, bones, and joints) and compromise the function of the hand. The treatment objectives in these injuries are, in order of importance, save the life, save the limb, and restore the function. The initial care is one of the most important aspects in the treatment of catastrophic injuries of the hand. The general principles of management are debride devitalized tissue, restore the vascularization, provide rigid skeletal fixation, repair or reconstruct all damaged structures, and provide adequate soft tissue coverage. The concept of useful hand meets the following requirements: have at least 3 fingers of normal length, have at least proximal interphalangeal joint motion of the fingers, have near normal sensitivity, and have a functional opposing thumb or finger. Catastrophic injuries are not common in the pediatric population, but when they occur, they are often not properly managed. Around the world, many of the patients who suffer catastrophic injuries in the hand receive only skin coverage, and the hand reconstruction is made with secondary procedures, with poor functional results and lengthy hospital stays. Materials and Methods: We present our series of 25 cases of catastrophic hand injuries in pediatric patients aged 2 to 17 years with grade II to IV of the Hand Injury Severity Scoring System, which were managed by our team between 2010 and 2014. The main cause of injury was motor vehicle accident, followed by mangling by a machine. In all these patients, an attempt was made to repair or reconstruct all damaged structures in 1 surgical sitting, to avoid lengthy hospital stays, move the hand and fingers as quickly as possible, and diminish the psychological damage these injuries cause. Free flaps were used in 19 of the patients. No pedicled flaps were done in any of the patients, in order to be able to start the therapy program very early, sometimes on the first postoperative day. The range of surgical procedures performed in these patients was 1 to 3 surgeries. The initial reconstruction surgery was complemented in these cases with other 2 procedures such as flap thinning, hardware removal, secondary tendon grafting, etc. Results: Patients were assessed at least 1 year after the initial surgery with the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) disability instrument (which has been validated to use on older children). In average, all patients scored 18 or better. The patients and their parents also evaluated cosmetic appearance. Conclusions: It is very important to consider special factors in the pediatric population, such as the size of anatomical structures, compliance with treatment, rehabilitation of the patient, and the psychological and emotional complications for the child and their families. We show the importance of the initial total hand reconstruction in the pediatric population in the treatment of catastrophic injuries of the hand; this approach gives the child the opportunity to have an aesthetically acceptable and functional hand in the shortest time possible.

Spectrum of hand injuries and their management at a tertiary care hospital using the hand injury scoring system

Background: Hand injuries are a major health problem all around the world; both in developing as well as developed countries. There are various causes of hand injuries which include occupational injuries, leisure activities, road traffic accidents, falls and other domestic injuries. The aim of the present study was to create a database of hand injury patterns in PIMS for assessing and scoring the severity of hand injury. Methods: This was a descriptive study that analyzed 442 hand injuries that presented to the department of emergency services and the out-patient departments of plastic and general surgery in the PIMS, Puducherry, India. The demographics of the hand injuries have been analyzed and studied. Scoring of the hand injuries has been done by the hand injury severity scoring system (HISS).The management that was carried out for these patients has been documented and recorded. Results: A total 442 patients were included in the study. Among them 379 (85.75%) cases were male and 63 (14.25%) patients were female. Female subjects were more commonly affected in two age groups (1-15, 45-60). The distribution of the nature and etiology of injuries in both genders was similar, Occupational and crush injuries being the dominant mode of injury in both genders. 237 (53.6%) patients sustained injuries to their dominant hand, while 205 (46.4%) sustained injuries to their non-dominant hand. 31.09% of dominant hand injuries were found to be mild in severity. 28.43% of non-dominant hand injuries were found to be major in severity. There was an even distribution of injuries between severity scores among all the patients. The duration of hospital stay was increased with severity of hand injury. 221 (50%) patients followed up for less than one month following their hand injuries whereas 69 (15.61%) cases were lost to follow up. Among the followed up patients, 126 (74.12%) subjects said they were normal at follow up and 44 (25.88%) said they had some residual impairment following their hand injuries. Of them, daily activities of 33 patients were affected depending upon the severity of injury. 409 (92.53%) patients required some form of surgical treatment, whereas 33 (7.47%) patients required only conservative treatment for their hand injuries. Conclusions: HISS presented to be the important system for assigning the patients according to the score, in directing the patients to the precise management and seems to be popular for excellent functional outcome.

The relationship of psychological status and social factors with hand function recovery in patients with hand injury: a preliminary study

Objective To investigate the incidence of psychological diseases in patients with occupational hand injury and the correlation of psychological status and social factors with hand function recovery.Methods A total of 231 patients with occupational hand injuries were involved in this study.Sociodemographic characteristics of the patients and severity of the injury were collected.Modified hand injury severity scoring system (MHISS) was used to document severity of the injury.Psychological status was assessed using the posttraumatic stress disorder symptom scale-interview (PSS-Ⅰ),the Beck depression inventory (BDI) and the self-rating anxiety scale (SAS).Social support was assessed using Social Support Questionnaire.Hand function was assessed using Disability of Arm,Shoulder and Hand (DASH).The SPSS 17.0 was used to analyze the correlation of the factors.Results Of the 231 patients,the incidence of posttraumatic stress disorder (PTSD) was 40.7％,anxiety was 22.9％ and depression was 39.8％.Hand function was closely negatively correlated with anxiety (P =0.025),depression (P ＜ 0.001),PTSD (P =0.002) and severity of hand injury (P =0.040).Pain was closely correlated with anxiety (P =0.007),depression (P =0.005),PTSD (P =0.004),social support (P =0.043) and severity of hand injury (P =0.036).The situation of PTSD (P =0.046) and pain (P =0.043) was significantly different among patients with different payment options for hospitalization cost.Conclusion The incidence of psychological problems was significantly higher in patients with acute hand injuries.The psychological status and social support were closely correlated with hand function recovery and pain.The payment option for hospitalization cost was the most significant social factor that affected PTSD and pain. Key words: Hand injuries; Pain; Posttraumatic stress disorder; Health care cost

Prediction of hand strength by hand injury severity scoring system in hand injured patients

Purpose: Hand strength is a key component in human hand function, especially to those with strength-required jobs. To evaluate post-injury hand strength, this study was conducted to assess the predictability of hand injury severity scoring (HISS) system to hand strength after a period of recovery. Methods: In this retrospective study, 80 traumatic hand-injured subjects were recruited. Hand strength tests measured by dynamometers were performed by subjects in ways of palmar pinch, lateral pinch and cylindrical grip. The logistic regression models were used to evaluate the risk of poor hand strength among the severities represented by HISS scores. Results: A positive correlation exists between the differences of the strength of two hands, and the severity shown by HISS system in the poorer half of subjects. The risk to be in poorer half of palmar pinch subtest is significant in moderate subgroup of HISS severity. The risk to be in poorer half of cylindrical grip subtest is significant in major subgroup of HISS severity. The risk to be in poorer half of palmar pinch and cylindrical grip subtests is significant in skeletal component of HISS system. Conclusions: HISS is a descriptive severity scoring system to hand injury and also a useful instrument to predict functional outcome. This study revealed the HISS system may predict post-injury hand strength after recovery.Implications for Rehabilitation: Hand injuryTraumatic hand injury results in considerable loss of personal productivity and increased social burden. Hand injury severity scoring (HISS) system could be an adequate predictor to post-injury hand strength.Early rehabilitation intervention is mandatory to those with anticipatory poor hand strength to improve outcomes.Full motor recovery of hand injury may take years to complete. Further training is warranted to those with severe hand injury.

Assessment of the severity of injuries to hands by powered wood splitters

Our aim was to rate the severity of injuries to hands by powered wood splitters. The patients were identified from a computerised registry, and the cause of injury was confirmed by written questionnaire and structured telephone interview. Information about the anatomy of the injury was gathered from patients' records and radiographs. Severity of injury was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score (ISS). The reliability of HISS rating was tested. The mean Hand Injury Severity Score (HISS) was 63 and the mean ISS was 3.7. Twenty-five (19%) of patients had minor, 41 (31%) had moderate, 30 (23%) had severe, and 35 (27 %) had major injuries when scored by the HISS system. Children's injuries were more severe than those of adults. There was no difference in severity between injuries made by wedge and screw splitters. It is not possible to avoid serious hand injuries from powered wood splitters completely by prohibiting one of the two main types of splitter.

DASH and sollerman test scores after hand injury from powered wood splitters

The purpose of the study was to describe the outcome after hand injury from powered wood splitters, and to investigate the relation between injury severity and outcome. Injury severity was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score method. The patients were evaluated with the Disabilities of the Arm Shoulder and Hand outcome questionnaire (DASH), and 26 of the most severely injured patients were evaluated with the Sollerman test. The mean DASH score was moderately elevated at 15, indicating that many of these patients have sequelae. A statistically significant correlation between HISS and DASH scores was found, implying that initial injury severity is of importance for outcome. The mean Sollerman score in the injured hand was 66, which amounts to a significantly impaired hand function.

Coping strategies in daily occupations 3 months after a severe or major hand injury

Coping strategies used in performing daily occupations 3 months after a severe or major hand injury were explored. A semi-structured interview was performed with 13 participants with hand injuries based on Hand Injury Severity Scoring System and analysed using content analysis. Six groups of strategies were identified: 'Changing performance of daily occupations', 'Actively processing trauma experience', 'Changing occupational patterns', 'Receiving assistance', 'Using emotional strategies' and 'Keeping up a social network'. The problem- and emotional-solving strategies identified in this study can be used to support other patients early in rehabilitation. Patients with few coping strategies should be recognized. Information and practical handouts to patients, therapists and relatives should stimulate and help patients with hand problems enabling in meaningful occupations and preventing unnecessary stress. Furthermore, social support should be encouraged and family should be actively involved in rehabilitation. To insure trustworthiness, member checks were used on four randomly selected participants, but could possibly be used with all participants. Further research is needed in a longitudinal study to explore which coping strategies or adaptation patients use to perform daily occupations at a later stage.

Prediction of hand function after occupational hand injury by evaluation of initial anatomical severity

Purpose. To examine the relationship between initial anatomic severity evaluated by the Hand Injury Severity Scoring (HISS) system and recovered hand function evaluated by the Purdue Pegboard after occupational hand injury.Method. In the retrospective cohort study, 95 patients hospitalized between 1 January 2000 and 31 December 2003 for surgery due to occupational hand injury were recruited. The HISS scores were obtained by chart review by a surgeon. The Purdue Pegboard was performed at least 6 months after the injury by well-trained occupational therapists. The Purdue Pegboard scores were compared with the initial HISS scores by simple regression, multiple regression and logistic regression analysis.Results. The total HISS score was negatively correlated with scores of the Purdue Pegboard subtests, including injured-hand, both-hands, and assembly. The risk of having low injured-hand score (<13) was significantly increased in workers with initial major severity (HISS ≥ 101), with OR 9.57 (95% CI 1.4 – 94.8). The risk of having low both-hands score (<10) was significantly increased in workers with initial severe and major severity (HISS of 51 – 100 and ≥101), with OR 4.5 (95% CI 1.1 – 21.8) and OR 25 (95% CI 3.5 – 263). The risk of having low assembly score (<25) was significantly increased in workers with initial major severity (HISS ≥ 101), with OR 9.0 (95% CI 1.3 – 72.5).Conclusion. The study showed that after occupational hand injury, initial anatomic severity evaluated by the HISS system could predict hand function after recovery.

Ein einfaches Bewertungssystem zur Einschätzung von Handverletzungen hinsichtlich der resultierenden Arbeitsunfähigkeit

Hintergrund: Bei Handverletzungen besteht ein Interesse, möglichst frühzeitig anhand des Verletzungsmusters die voraussichtliche Dauer der Arbeitsunfähigkeit einzuschätzen. Existierende Bewertungsschemata wie z. B. der HISS-Score (Hand Injury Severity Scoring System) sind komplex und aufwändig zu bestimmen. Material und Methoden: Basierend auf bei Handverletzungen auftretenden Verletzungsmustern bzw. der beteiligten Strukturen wurde ein einfach zu bestimmendes Bewertungssystem entwickelt. Anhand dieses Schemas wurden 180 Arbeitsunfälle (1997 - 2002), bei denen isoliert eine Hand betroffen war, prospektiv analysiert. Das mittlere Alter der Verletzten betrug 37,9 (18 - 65) Jahre, der Frauenanteil 11 %. Ergebnisse: Die häufigste Verletzungslokalisation waren mit 55 % der Fälle die Langfinger, von denen wiederum der Zeigefinger am häufigsten betroffen war. Die längste Dauer der Arbeitsunfähigkeit wurde durch revaskularisationspflichtige Schäden und Weichteildefekte verursacht. Die Korrelation zwischen dem neu entwickelten Bewertungsschema und der Dauer der AU (p < 0,0001, r = 0,46) war stärker als die Korrelation zwischen HISS-Wert und Dauer der AU (p < 0,0001, r = 0,37). Weiterhin ergab sich eine signifikante Korrelation zwischen dem Bewertungsschema und der Dauer des stationären Aufenthaltes (p < 0,0001). Schlussfolgerung: Durch den Score kann schnell und auf einfache Weise eine grobe Einschätzung der voraussichtlichen Dauer der Arbeitsunfähigkeit erfolgen.

Einschätzung der Verletzungsschwere sowie der Dauer der Arbeitsunfähigkeit bei Handverletzungen mit dem HISS-Bewertungsschema

The estimation of the time off work depending on the injury pattern and severity is of major interest in the treatment of hand injuries. The predictive value of the HISS score (Hand Injury Severity Scoring System) was evaluated. According to this score, 184 work-related injuries (1999 to 2002) were analyzed prospectively, excluding injuries of both hands. The median age was 37.9 years (18 to 65 years), 11 % of the patients were female. A significant correlation was established between the HISS score and the time off work (p < 0.0001, r = 0.51). The score also correlated with the degree of work incapacity (p < 0.0001). Our data confirm the predictive value of the HISS score for the early estimation of the time off work resulting from hand injuries. However, the estimation is limited to injuries distal to the wrist.

Outcome of hand trauma: the hand injury severity scoring system (HISS) and subsequent impairment and disability

This study was designed to evaluate correlations between the hand injury severity scoring system (HISS) and measures of impairment and disability obtained 6 months after a hand injury. A statistically significant positive correlation was found between the severity of the injury (HISS) and residual impairment, as measured with the American Medical Association's (AMA) “Guides to the evaluation of permanent impairment, 4th edition”. No statistically significant correlation was found between the severity of the injury (HISS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, which measures disability from the patient's perspective. There was however a statistically significant correlation between AMA total body impairment measured and the results of the DASH questionnaire. The results indicate the potential of the HISS for predicting the final impairment after hand injuries.

The hand injury severity scoring system

A descriptive severity scoring system for injuries to the hand, distal to the carpus, has been designed. Each ray of the hand is assessed separately. Each ray's score is then multiplied by a weighting factor for that ray and added to the scores of the other rays to obtain a total score for the injury. This system has been tested on a series of specimen injuries and compared with the opinion of experienced hand surgeons. A retrospective study of hand injuries has also been conducted, and the Hand Injury Severity Score (HISS) has been found to closely correlate with return to work. Four grades of increasing severity of hand injury have been described. Although this system has been designed as a research tool, it is envisaged that it would be a useful immediate measure of severity and a guide to likely outcome.

The hand injury severity scoring system

A descriptive severity scoring system for injuries to the hand, distal to the carpus, has been designed. Each ray of the hand is assessed separately. Each ray's score is then multiplied by a weighting factor for that ray and added to the scores of the other rays to obtain a total score for the injury. This system has been tested on a series of specimen injuries and compared with the opinion of experienced hand surgeons. A retrospective study of hand injuries has also been conducted, and the Hand Injury Severity Score (HISS) has been found to closely correlate with return to work. Four grades of increasing severity of hand injury have been described. Although this system has been designed as a research tool, it is envisaged that it would be a useful immediate measure of severity and a guide to likely outcome.

Digital Nerve Repair

The purpose of this study was to measure the relationship between severity of injury and sensibility outcome. This was done by a retrospective study of 37 digital nerve repairs in 26 patients, with a mean follow-up of 35 months. All patients underwent complete hand examination and standard nerve testing, including static and moving two-point discrimination, Semmes-Weinstein monofilaments (SWMF), object recognition, and the pick-up test. A hand injury severity scoring system based on wound characteristics, mechanism of injury, and number of structures involved was then developed. Severity grading led to three classes, and each study group was well matched. Subjectively, all patients considered their outcome as either good or excellent. Objective results are reviewed individually for each test, with the overall combined result of static and moving two-point discrimination being excellent (Highet S4) in 81% for class I, 41% for class II, and 31% for class III, all different at a statistically significant level. We concluded that the severity of injury in the hand can be graded and does have a relationship to the functional end result of digital nerve repair.