A primer on use of decision analysis methodology in hand surgery.

Decision analysis is a method of probabilistic reasoning and decision-making under conditions of uncertainty. These methods are being used increasingly in hand surgery and medicine in general. It is important for hand surgeons to understand these techniques and how to interpret the results from these studies. Performing a decision analysis involves (1) defining a specific question, (2) creating a model to frame the question, (3) assigning value to outcomes in the model, (4) assigning probabilities to chance events in the model, (5) identifying the best strategy within the model, (6) sensitivity analysis, and (7) model refinement. It is important to recognize the limitations inherent in decision analysis but also to understand its value in overcoming clinical uncertainty by employing a practical technique of modeling choices and outcomes.