Attrition rates in hand and wrist trauma trials: a systematic review and meta-analysis protocol

BACKGROUND: Hand and wrist injuries are increasingly prevalent and impact individuals' abilities to participate in society and generate income. Attrition in the hand and wrist trauma treatment time course and trials is a recognised issue, with patients disengaging from follow-up due to various logistical and socioeconomic barriers. While several studies have addressed this, the timeline and causes of attrition in trials remain inconsistent. This meta-analysis aims to evaluate the attrition rates among patients with hand and wrist trauma across all prospective randomised controlled trials (RCTs), identifying critical time points for attrition, at-risk patient populations, and comparing surgical versus non-surgical interventions. METHODS: The databases Embase, PubMed, and CENRAL will be searched. Abstracts will be screened by two persons independently to identify eligible studies. The systematic review will include prospective randomised controlled trials in participants with hand and/or wrist trauma. The review will consider patient demographics and proportions of attrition rates at time frames of 30 days, 90 days, 6 months, and 12 months. The meta-analysis will compare attrition time frame considering patient demographics, intervention and injury types, and documented attrition reasons. The Cochrane risk-of-bias tool 2 will be used to assess the risk of methodological bias in the randomised controlled trials. DISCUSSION: This systematic review and meta-analysis will address the critical gap in understanding attrition rates in hand/wrist trauma research. By identifying which patients are at risk and when attrition occurs, we aim to develop a toolkit to improve follow-up rates and, in turn, patient outcomes. Ultimately, the findings will inform future clinical practices and research methodologies, contributing to more representative and robust evidence in hand/wrist trauma management. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024588638.