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Open Access Research article

Costs and outcome for serious hand and arm injuries during the first year after trauma – a prospective study

Hans-Eric Rosberg12, Katarina Steen Carlsson34, Ragnhild I Cederlund1256, Eva Ramel56 and Lars B Dahlin12*

Author affiliations

1 Department of Hand Surgery, Skåne University Hospital, Malmö, S-205 02, Sweden

2 Department of Clinical Sciences Malmö – Hand Surgery, Lund University, Malmö, S-205 02, Sweden

3 The Swedish Institute for Health Economics, Lund, Sweden

4 Health Economics, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden

5 Division of Occupational Therapy and Gerontology, Lund University, Malmö and Lund, Lund, Sweden

6 Department of Health Sciences, Lund University, Malmö and Lund, Lund, Sweden

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Citation and License

BMC Public Health 2013, 13:501  doi:10.1186/1471-2458-13-501

Published: 24 May 2013

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.

Keywords:
Hand injury; HISS; DASH; EQ-5D; Costs; Health care costs; Complex injury; Nerve injury