Surveillance for nonfatal work-related injuries in Alaska, 1991-1995

Using Workers' Compensation Claims Data to Describe Nonfatal Injuries among Workers in Alaska

BACKGROUND

To gain a better understanding of nonfatal injuries in Alaska, underutilized data sources such as workers' compensation claims must be analyzed. The purpose of the current study was to utilize workers' compensation claims data to estimate the risk of nonfatal, work-related injuries among occupations in Alaska, characterize injury patterns, and prioritize future research.

METHODS

A dataset with information on all submitted claims during 2014-2015 was provided for analysis. Claims were manually reviewed and coded. For inclusion in this study, claims had to represent incidents that resulted in a nonfatal acute traumatic injury, occurred in Alaska during 2014-2015, and were approved for compensation.

RESULTS

Construction workers had the highest number of injuries (2,220), but a rate lower than the overall rate (34 per 1,000 construction workers, compared to 40 per 1,000 workers overall). Fire fighters had the highest rate of injuries on the job, with 162 injuries per 1,000 workers, followed by law enforcement officers with 121 injuries per 1,000 workers. The most common types of injuries across all occupations were sprains/strains/tears, contusions, and lacerations.

CONCLUSION

The successful use of Alaska workers' compensation data demonstrates that the information provided in the claims dataset is meaningful for epidemiologic research. The predominance of sprains, strains, and tears among all occupations in Alaska indicates that ergonomic interventions to prevent overexertion are needed. These findings will be used to promote and guide future injury prevention research and interventions.

Work-related nonfatal injuries in Alaska's aviation industry, 2000-2013

Aviation is a critical component of life in Alaska, connecting communities off the road system across the state. Crash-related fatalities in the state are well understood and many intervention efforts have been aimed at reducing aircraft crashes and resulting fatalities; however, nonfatal injuries among workers who perform aviation-related duties have not been studied in Alaska. This study aimed to characterize hospitalized nonfatal injuries among these workers using data from the Alaska Trauma Registry. During 2000-2013, 28 crash-related and 89 non-crash injuries were identified, spanning various occupational groups. Falls were a major cause of injuries, accounting for over half of non-crash injuries. Based on the study findings, aviation stakeholders should review existing policies and procedures regarding aircraft restraint systems, fall protection, and other injury prevention strategies. To supplement these findings, further study describing injuries that did not result in hospitalization is recommended.

Work-related injuries in the Alaska logging industry, 1991-2014

BACKGROUND

Although loggers in Alaska are at high risk for occupational injury, no comprehensive review of such injuries has been performed since the mid-1990s. We investigated work-related injuries in the Alaska logging industry during 1991-2014.

METHODS

Using data from the Alaska Trauma Registry and the Alaska Occupational Injury Surveillance System, we described fatal and nonfatal injuries by factors including worker sex and age, timing and geographic location of injuries, and four injury characteristics. Annual injury rates and associated 5-year simple moving averages were calculated.

RESULTS

We identified an increase in the 5-year simple moving averages of fatal injury rates beginning around 2005. While injury characteristics were largely consistent between the first 14 and most recent 10 years of the investigation, the size of logging companies declined significantly between these periods.

CONCLUSIONS

Factors associated with declines in the size of Alaska logging companies might have contributed to the observed increase in fatal injury rates.

State Trauma Registries as a Resource for Occupational Injury Surveillance and Research: Lessons From Washington State, 1998-2009

OBJECTIVES

Work-related traumatic injury is a leading cause of death and disability among US workers. Occupational injury surveillance is necessary for effective prevention planning and assessing progress toward Healthy People 2020 objectives. Our objectives were to (1) describe the Washington State Trauma Registry (WTR) as a resource for occupational injury surveillance and research, (2) compare the WTR with 2 population-based data sources more widely used for these purposes, and (3) compare the number of injuries ascertained by the WTR with other data sources.

METHODS

We linked WTR records to hospital discharge records in the Comprehensive Hospital Abstract Reporting System for 2009 and to workers' compensation claims from the Washington State Department of Labor and Industries for 1998 to 2008. We assessed the 3 data sources for overlap, concordance, and case ascertainment.

RESULTS

Of 9185 work-related injuries in the WTR, 3380 (37%) did not link to workers' compensation claims. Use of payer information in hospital discharge records along with the WTR work-relatedness field identified 20% more linked injuries as work related (n = 720) than did use of payer information alone (n = 602). The WTR identified substantial numbers of work-related injuries that were not identified through workers' compensation or hospital discharge records.

CONCLUSIONS

Workers' compensation and hospital discharge databases are important but incomplete data sources for work-related injuries; many work-related injuries are not billed to, reported to, or covered by workers' compensation. Trauma registries are well positioned to capture severe work-related injuries and should be included in comprehensive injury surveillance efforts.

Musculoskeletal Disorders in Northeast Lobstermen

BACKGROUND

The objective of this study was to report on the prevalence of musculoskeletal pain in lobstermen in the northeast USA.

METHODS

Crews were randomly selected from those licensed to fish in Maine and Massachusetts and followed prospectively. The survey used a Nordic Musculoskeletal Questionnaire format to characterize musculoskeletal disorders.

RESULTS

A total of 395 individuals participated. One half of the respondents reported low back pain. Back pain was attributed to or exacerbated by lobstering. Low back pain was prevalent among both captains and sternmen, while sternmen reported more hand/wrist pain than captains. Multiple locations for pain were common in individual participants.

CONCLUSION

Equipment or technology to assist material handling should be a priority, as the body segments with high prevalence of pain (back, hand/wrists, shoulders, knees) are all affected by the repetitive and forceful handling of the lobster traps.

Linkage and concordance of Trauma Registry and hospital discharge records: lessons for occupational injury surveillance and research

OBJECTIVE

Occupational injury researchers typically use payer to identify work-related injuries in hospital discharge records. Many trauma registries contain a work-related field, independent of payer. Linked trauma registry and hospital discharge records were used to assess data field concordance and to assess the validity of using payer or external cause of injury (E-codes) to identify work-related injuries.

METHODS

Washington State Trauma Registry records were linked to hospital discharges (year 2009).

RESULTS

There was substantial agreement between Washington State Trauma Registry and hospital discharge records for workers' compensation as primary payer. E-code based methods of identifying occupational injuries had high specificity (more than 99%) but low sensitivity (less than 14%). Payer was 76% sensitive and 98% specific.

CONCLUSIONS

This study found substantial agreement for data fields key to occupational injury surveillance and research. Nevertheless, many work-related injuries could not be identified using hospital discharge records.

The economic and logistical burden of care for severe work-related injuries in a level 1 tertiary care trauma referral center

BACKGROUND

Work-related injuries (WRIs) represent a significant economic and logistical burden to healthcare systems.

METHODS

All patients with severe WRIs (Injury Severity Score [ISS] ≥ 12) (1995 to 2013) were compared with patients with non-WRIs using standard methodology (P < .05).

RESULTS

A total of 1,270 (8.5%) trauma admissions were for severe WRIs (mean age = 45 years, male:female ratio = 2.8:1, mean ISS = 22.7). Compared with patients with non-WRIs, WRI patients were younger, male, and had fewer comorbidities. Despite equivalent ISS, WRIs had a longer intensive care unit length of stay, length of mechanical ventilation, and number of surgical/operative procedures. Fewer patients with WRIs died in hospital and more were discharged home without support services. The acute care economic burden of WRIs was higher (because of intensive care unit and operating theatre, and physician compensation) (all analyses, P < .05).

CONCLUSION

Patients with WRIs were younger, less comorbid, male, and had significantly higher utilization of acute care resources despite a similar ISS.

Occupational injury trends derived from trauma registry and hospital discharge records: lessons for surveillance and research

OBJECTIVE

The suitability of the Washington State Trauma Registry (WTR) for occupational injury surveillance was assessed via comparing estimated rates and trends with those derived from state hospital discharge data.

METHODS

Descriptive methods and negative binomial regression were used to model occupational injury trends (1998 to 2009).

RESULTS

Nonlinear trends based on WTR data closely tracked those based on hospital discharge data, beginning about 2002. Rate estimates differed somewhat by data source and were most similar when a severity threshold was applied. Conclusions regarding temporal trends in work-related injury rates were the same using either data source.

CONCLUSIONS

This study found substantial similarity between occupational injury trends estimated using either WTR or hospital discharge data. We conclude that a mature state trauma registry with mandatory reporting requirements can be used for surveillance of severe work-related traumatic injuries.

Work-related traumatic injuries onboard freezer-trawlers and freezer-longliners operating in Alaskan waters during 2001-2012

BACKGROUND

Workers onboard freezer-trawl (FT) and freezer-longline (FL) vessels in Alaska may be at high risk for fatal and non-fatal injuries.

METHODS

Traumatic occupational injuries onboard vessels in the FT and FL fleets were identified through two government data sources.

RESULTS

The annual risk of fatal injuries was 125 per 100,000 FTEs in the FT fleet, and 63 per 100,000 FTEs in the FL fleet. The annual risk of non-fatal injuries was 43 per 1,000 FTEs in the FT fleet and 35 per 1,000 FTEs in the FL fleet. The majority of injuries in the FT fleet occurred in the factories and freezer holds, whereas the most common injuries in the FL fleet occurred on deck while working the fishing gear.

CONCLUSIONS

The findings confirmed that workers in those fleets were at high risk for work-related injuries. Injury prevention should focus on removing hazards in the work processes injuring the most workers.

Case identification of work-related traumatic brain injury using the occupational injury and illness classification system

OBJECTIVES

Traumatic brain injury (TBI) is one of the most common, costly, and disabling occupational injuries. Objectives included determining whether work-related TBI could be reliably identified using the Occupational Injury and Illness Classification System (OIICS) and describing challenges in developing an OIICS-based TBI case definition.

METHODS

Washington State trauma registry reports and workers' compensation claims were linked (1998 to 2008). Trauma registry diagnoses were used as the gold standard for six OIICS-based TBI case definitions.

RESULTS

The OIICS-based case definitions were highly specific but had low sensitivity, capturing less than a third of fatal and nonfatal TBI.

CONCLUSION

The use of OIICS versus International Classification of Diseases-Ninth Revision-Clinical Modification codes underestimated TBI and changed the attributable cause distribution, with potential implications for prevention efforts. Surveillance methods that can more fully and accurately capture the impact of work-related TBI across the United States are needed.

Predicting work-related disability and medical cost outcomes: a comparison of injury severity scoring methods

INTRODUCTION

Acute work-related trauma is a leading cause of death and disability among U.S. workers. Occupational health services researchers have described the pressing need to identify valid injury severity measures for purposes such as case-mix adjustment and the construction of appropriate comparison groups in programme evaluation, intervention, quality improvement, and outcome studies. The objective of this study was to compare the performance of several injury severity scores and scoring methods in the context of predicting work-related disability and medical cost outcomes.

METHODS

Washington State Trauma Registry (WTR) records for injuries treated from 1998 to 2008 were linked with workers' compensation claims. Several Abbreviated Injury Scale (AIS)-based injury severity measures (ISS, New ISS, maximum AIS) were estimated directly from ICD-9-CM codes using two software packages: (1) ICDMAP-90, and (2) Stata's user-written ICDPIC programme (ICDPIC). ICDMAP-90 and ICDPIC scores were compared with existing WTR scores using the Akaike Information Criterion, amount of variance explained, and estimated effects on outcomes. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modelled using linear regression.

RESULTS

The linked sample contained 6052 work-related injury events. There was substantial agreement between WTR scores and those estimated by ICDMAP-90 (kappa=0.73), and between WTR scores and those estimated by ICDPIC (kappa=0.68). Work disability and medical costs increased monotonically with injury severity, and injury severity was a significant predictor of work disability and medical cost outcomes in all models. WTR and ICDMAP-90 scores performed better with regard to predicting outcomes than did ICDPIC scores, but effect estimates were similar. Of the three severity measures, maxAIS was usually weakest, except when predicting total permanent disability.

CONCLUSIONS

Injury severity was significantly associated with work disability and medical cost outcomes for work-related injuries. Injury severity can be estimated using either ICDMAP-90 or ICDPIC when ICD-9-CM codes are available. We observed little practical difference between severity measures or scoring methods. This study demonstrated that using existing software to estimate injury severity may be useful to enhance occupational injury surveillance and research.

Who pays for work-related traumatic injuries? Payer distribution in washington state by ethnicity, injury severity, and year (1998-2008)

BACKGROUND

Acute work-related trauma is a leading cause of death and disability for U.S. workers but it is difficult to obtain information about injured workers not covered by workers' compensation (WC). This study aimed to: (1) describe trends in expected payer and linkage to WC claims, (2) compare characteristics of injured workers who did and did not have a linked WC claim, and (3) describe variation in expected payer and linkage to WC claims by ethnicity and injury severity.

METHODS

Data for injuries occurring from 1998 through 2008 were obtained from the Washington State Trauma Registry and linked to WC claims.

RESULTS

We found that 27% of work-related traumatic injuries did not have WC listed as a payer, while 37% did not link to a WC claim. Among those with WC listed as a payer, the odds of having a linked WC claim were 57% lower for workers with other non-WC insurance compared with the otherwise uninsured. Latinos were more likely to have a linked WC claim compared with non-Latinos, but there was no significant difference after partially controlling for WC-covered employment and other insurance.

CONCLUSIONS

This study demonstrated the importance of considering differential access to other insurance coverage and adaptation by health care settings to financial pressures when assessing trends in occupational injury incidence and reporting, especially when using WC as a proxy for work-relatedness. The addition of occupation, industry, and work status to trauma registries and hospital discharge databases would improve surveillance, research, policy and prevention efforts.

The burden of traumatic brain injury among adolescent and young adult workers in Washington State

OBJECTIVE

This study describes injury characteristics and costs of work-related traumatic brain injury (WRTBI) among 16-24 year olds in Washington State between 1998 and 2008.

METHODS

WRTBIs were identified in the Washington Trauma Registry (WTR) and linked to workers' compensation (WC) claims data. Medical and time-loss compensation costs were compared between workers with isolated TBI and TBI with other trauma.

RESULTS

Of 273 WRTBI cases identified, most (61.5%) were TBI with other trauma. One-third of WRTBI did not link to a WC claim. Medical costs averaged $88,307 (median $16,426) for isolated TBI cases, compared to $73,669 (median $41,167) for TBI with other trauma.

CONCLUSIONS

Results highlight the financial impact of WRTBI among young workers. Multiple data sources provided a more comprehensive picture than a single data source alone. This linked-data approach holds great potential for future traumatic occupational injury research.

IMPACT ON INDUSTRY

TBI among young workers not only involves long-term health and psychological impacts, but is costly as well.

Predicting work-related disability and medical cost outcomes: estimating injury severity scores from workers' compensation data

PURPOSE

Acute work-related trauma is a leading cause of death and disability among US workers. The research objectives were to assess: (1) the feasibility of estimating Abbreviated Injury Scale-based injury severity scores (ISS) from ICD-9-CM codes available in workers' compensation (WC) medical billing data, (2) whether ISS predicts work-related disability and medical cost outcomes, (3) whether ISS adds value over other injury severity proxies, and (4) whether the utility of ISS differs for an all-injury sample compared with three specific injury samples (amputations, extremity fractures, traumatic brain injury).

METHODS

ISS was estimated from ICD-9-CM codes using Stata's user-written -icdpic- program for 208,522 compensable nonfatal WC claims for workers injured in Washington State from 1998 to 2008. The Akaike Information Criterion and R(2) were used to compare severity measures. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modeled using linear regression.

RESULTS

Work disability and medical costs increased monotonically with injury severity. For a subset of 4,301 claims linked to the Washington State Trauma Registry (WTR), there was moderate agreement between WC-based ISS and WTR-based ISS. Including ISS together with an early hospitalization indicator resulted in the most informative models; however, early hospitalization is a more downstream measure.

CONCLUSIONS

ISS was significantly associated with work disability and medical cost outcomes for work-related injuries. Injury severity should be considered as a potential confounder for occupational injury intervention, program evaluation, or outcome studies, and can be estimated using existing software when ICD-9-CM codes are available.

Occupational Injury Surveillance of Traumatic Injuries in Illinois, Using the Illinois Trauma Registry: 1995–2003

BACKGROUND

Trauma registries continue to be underutilized for surveillance, despite providing data on the most severe injuries with a level of detail not available in national data sets or workers' compensation files.

METHODS

We evaluate trends and patterns of traumatic occupational injuries from the Illinois Trauma Registry (ITR).

RESULTS

Between 1995 and 2003, 44.4 of every 100,000 Illinois workers (age-adjusted) suffered work-related, nonfatal traumatic injuries. The majority of workers suffering traumatic injuries were white males younger than 55 years old. Falls were the most common cause of injury, and fracture of the extremities was the most common type of injury experienced by Illinois workers. Approximately 8% of all workers required either partial or total ambulatory assistance at time of discharge.

CONCLUSION

The ITR provides detailed and complete data regarding the most severe occupational injuries.

CLINICAL SIGNIFICANCE

In contrast to reports from national surveillance data sets, we do not observe a significant decline in occupational injuries between 1995 and 2003. Trauma registries should be used more frequently for surveillance programs, because they provide detailed and reliable data regarding the most severe occupational injuries not available in other data sets.

Industrial sectors with high risk of women's hospital-treated injuries

BACKGROUND

Women's occupational injury rates are converging with those of males. Associations between female workers' hospital treated injury rates, industrial sector and injured body area were analyzed to provide for better-focused injury prevention of women's hazardous jobs.

METHODS

Females' standardized hospital treatment ratios (SHR) and the excess fraction for five body regions (head/neck, thorax, back, upper and lower extremities) were calculated for 58 industrial sectors for 1999-2003.

RESULTS

Five industrial sectors, "Cleaning, laundries and dry cleaners," "Transport of passengers," "Hotels and restaurants," "Hospitals" and "Transport of goods" had significantly high SHRs for all five body regions. The excess fraction for upper extremity injuries revealed that 14%-27% of injuries could theoretically have been avoided.

CONCLUSIONS

There is strong evidence for an association between women's hospital treated injuries and industrial sector. The results justify the need for gender-sensitive analyses to orient injury prevention programs.

Noise exposures aboard catcher/processor fishing vessels

BACKGROUND

Commercial fishing workers have extended work shifts and potential for 24 hr exposures to high noise. However, exposures in this industry have not been adequately characterized.

METHODS

Noise exposures aboard two catcher/processors (C/P) were assessed using dosimetry, sound-level mapping, and self-reported activities and hearing protection device (HPD) use. These data were combined to estimate work shift, non-work, and 24 hr overall exposure levels using several metrics. The length of time during which HPDs were worn was also used to calculate the effective protection received by crew members.

RESULTS

Nearly all workers had work shift and 24 hr noise levels that exceeded the relevant limits. After HPD use was accounted for, half of the 24 hr exposures remained above relevant limits. Non-work-shift noise contributed nothing to 24 hr exposure levels. HPDs reduced the average exposure by about 10 dBA, but not all workers wore them consistently.

CONCLUSIONS

The primary risk of hearing loss aboard the monitored vessels comes from work shift noise. Smaller vessels or vessels with different layouts may present more risk of hearing damage from non-work periods. Additional efforts are needed to increase use of HPDs or implement noise controls.

Factors associated with injuries occurring aboard vessels in Alaska: differences between residents and nonresidents

BACKGROUND

Over the past decade, visitors to Alaska have spent increasing amounts of time engaged in water-based recreational activities aboard vessels of various sizes. Serious vessel-related injuries to travelers in Alaska involve not only medical care from unfamiliar health care providers and facilities but also entail the loss of vacation time and the need for injured travelers to return to their homes under less than optimal traveling conditions.

METHODS

This study employed a retrospective, case-comparison analysis to identify differences in factors associated with recreational injuries acquired aboard watercraft that resulted in hospitalizations of residents and nonresidents of Alaska during 1991 to 2000. Tests of proportions were conducted to elucidate differences in demographic characteristics and injury precursors between the two subgroups. Specific injury outcomes were then tested for significance using odds ratios.

RESULTS

Alaska residents and nonresidents demonstrated significant differences for both demographic factors and factors describing events leading to injuries, and for injury outcomes. Nonresidents were more likely to be 65 years or older, female, and aboard cruise ships when injuries occurred. Nonresidents were more likely to suffer fracture injuries, to suffer injuries with Abbreviated Injury Scores greater than 2, to experience posthospital discharges to sites other than their homes, and to experience postinjury disabilities.

CONCLUSIONS

Alaska residents and nonresidents in this study showed significant differences in demographics, precipitating events, and injury outcomes. The findings lend support for targeted safety promotion programs.

Use of the CABS methodology to assess biomechanical stress in commercial crab fishermen

Commercial fishing is a job characterized by long hours in an unpredictable, dynamic natural environment and variable demands placed on the musculoskeletal system, requiring strength, coordination, and endurance. The focus of this project was in the quantification of the biomechanical stresses placed on the lumbar spine during the work activities of commercial crab fishermen. The continuous assessment of back stress (CABS) methodology was used to develop distributions describing the amount of time that each of the crew members on a two- or three-man crabbing crew spend at various levels of low back stress. The results of this analysis, expressed in terms of time-weighted histograms, show significant inter and intra-crewmember variability in the stress measures during regular daily work activities. For the three man crew, the captain has relatively low stress levels throughout the work day, while the mate performs high force (up to 30 kg), dynamic exertions while pulling the crab pots from the water up into the boat and high loads (20-40 kg) during the loading and unloading of the boat in the morning and evening, respectively. The third man of the crew experiences static awkward postures (forward flexed postures held for up to 5 min at a time) as he sorts and packs the crabs. For the two-man crew, the results show a more even distribution of the high stress activities between the crewmembers. The application of the results of this analysis for prioritization of work tasks for ergonomic intervention is discussed.

Ergonomic exposure case studies in Massachusetts fishing vessels

BACKGROUND

Musculoskeletal disorders may not have been studied as much as greater risks in the dangerous environment of commercial fishing. Primary prevention of risk for these kinds of injuries and illnesses begins by a detailed understanding of what risks are likely to be common in the different fisheries, and how those risks might be reduced.

METHODS

Ergonomic job analyses were conducted on three different types of fishing vessels in Massachusetts: gillnetting, otter trawling, and lobstering. Direct observation was used to link posture to task. Noise measurements, tool analysis, and cycle time measurements were also included.

RESULTS

Production speed, materials handling, and vessel movement contributed to musculoskeletal stress by affecting observable postural deviation, repetition, and forceful exertions.

CONCLUSIONS

Interventions to reduce ergonomic risk factors might be possible through utilization of below deck space in certain boats, through better technology, or through simple tool adjustments.

Changes in logging injury rates associated with use of feller-bunchers in West Virginia

PROBLEM

It is well documented that logging is one of the most dangerous occupations and industries in which to work, and trees fellers are at greatest risk of injury. The objective of this study was to determine whether West Virginia (WV) logging companies experienced a reduction in injuries after beginning to use feller-bunchers (tree cutting machines, which replace some of the work done with a chainsaw) during harvesting operations.

METHODS

WV workers compensation claims and employment data from 1995 to 2000 were used to calculate injury rates. Injury trends in the rest of the WV logging industry, not using feller-bunchers, were also assessed.

RESULTS

For 11 companies, the pre-feller-buncher injury claims rate was 19.4 per 100 workers and the post-feller-buncher rate was 5.2 per 100 workers. This was a significant difference, with an adjusted rate ratio of 2.8 (95% CI: 1.8-4.5) of pre to post claims. Struck by injuries also showed significant decline, with the pre-feller-buncher injury rate being 3.8 (95% CI: 1.8-8.2) times as great as post-feller-buncher rate. During the time of the study, the injury rate rose in the rest of the WV logging industry. The average cost of a workers compensation claim in the WV logging industry during the time of the study was approximately $10,400.

IMPACT ON INDUSTRY

As mechanization of logging tasks becomes more widespread, the WV logging industry as a whole may see substantial injury declines and a reduction in the total cost of injury claims. Struck by injuries, the most common and potentially fatal of logging injury types, appear to be particularly affected. However, logging operations in areas of very steep terrain where it is not possible to use these machines may need to rely on strategies other than feller-bunchers to reduce injuries.

Is it safe on deck? Fatal and non-fatal workplace injuries among Alaskan commercial fishermen

BACKGROUND

Commercial fishing in Alaska accounts for an occupational fatality rate that is 28 times the rate for all U.S. workers. Most deaths are attributed to vessel sinking or capsizing. However, many deaths and most non-fatal injuries are not related to vessel loss. This paper describes injuries that occur on the dock or on the fishing vessel.

METHODS

Data from fishing fatalities and non-fatal injuries between 1991-1998 were analyzed using the Alaska Occupational Injury Surveillance System and the Alaska Trauma Registry.

RESULTS

There were 60 workplace deaths unrelated to vessel loss; most from falls overboard, others from trauma caused by equipment on deck. There were 574 hospitalized injuries, often from falls on deck, entanglement in machinery, or being struck by an object.

SUMMARY

Fishing boats are hazardous working environments. Further efforts are required to prevent falls overboard and on deck, and to redesign or install safety features on fishing machinery and equipment.

Use of a national hospitalization register to identify industrial sectors carrying high risk of severe injuries: a three-year cohort study of more than 900,000 Danish men

BACKGROUND

Data indicates that Denmark has relatively high risks of occupational injuries. We evaluated all injuries resulting in hospitalization by occupation.

METHODS

All gainfully employed men younger than 60 in 1990 were divided into 47 industrial groups and followed using the National Inpatient Registry, for hospitalized injuries 1991-1993. Following ICD-8, injuries were grouped into six categories: head, upper extremities, back, trunk, lower extremities and ruptures, sprains and strains. Standardized industrial hospitalization ratios (SHRs) were calculated and Pearson's independence test was performed for each category.

RESULTS

Industrial differences were ascertained for each injury category. The highest associated injury category was upper extremity injuries ranging from SHR = 43 (fire services and salvage corps) to SHR = 209 (slaughterhouse industry). Carpentry, joinery, bricklaying and construction work had significantly high SHRs for all injury categories, whereas administrative work was significantly low throughout.

CONCLUSIONS

Occupational surveillance systems based on hospitalized injuries can be used to identify high-risk industries, and thereby suggest where to direct prevention efforts.

Compensation for occupational injury and disease in Norway: ranking of job groups

The health risk of various job groups in Norway was estimated by ranking them according to the annual occupational insurance costs per capita. This was done by dividing the costs of work-related injury and disease from 1991 to 1996 in various job groups by the number of workers in these groups. Occupational groups were also ranked according to total annual costs. The five occupational groups with the highest total costs were metalworkers, woodworkers, nursing-related workers, fisheries workers, and teachers. The groups with the highest annual cost per worker were shoe and leather workers, oil and gas extractors, fisheries workers, miners and quarry workers, and ship's officers. Fisheries workers and ship's officers were ranked among the top 10 positions on both lists and deserve priority in preventive measures.

Non-fatal occupational fall and slip injuries among commercial fishermen analyzed by use of the NOMESCO injury registration system

BACKGROUND

Fall injuries constitute a significant problem in commercial fishing and such injuries have hitherto not been the subject of closer analysis.

METHODS

The distribution and the characteristics of 582 occupational injuries among commercial fishermen are described by using data from an emergency department for the period 1990-1997, recorded in a special registration system.

RESULTS

Consistent with other investigations, injuries from falls made up 25% of all injuries; they were the cause of 28% of all contusions, 32% of all fractures, 61% of all sprains and strains, 40% of all injuries to lower extremities, and 62% of all injuries to the chest. The proportion of fall injuries in different age groups was U-shaped and constitutes around 40% for men both under 20 years and over 50 years of age, and around 20% for those between these ages. Frequent types of injury mechanisms other than falls and slips were: getting caught (22%), contact with objects or persons (28%), foreign body (9%), and cuts (9%).

CONCLUSIONS

Use of proportionate data gave a detailed description of injuries from falls and slips, showing important areas for prevention. To avoid a possible misclassification of fall injuries in future studies, it is recommended to include an extra specific variable: whether falling or slipping preceded the crash phase of the injury or not.

A state trauma registry as a tool for occupational injury surveillance

The goal of occupational surveillance is to identify and determine the magnitude of work-related disease and injury and workplace hazards for the purposes of focusing prevention programs and tracking their effectiveness. There are a number of databases that collect information on pieces of the puzzle of workplace exposure and adverse health outcomes. Other than that for the fatalities, none of these datasets specifically describes the most severe occupational injuries or their attendant disability. The goal of this study was to evaluate the usefulness of the Illinois Trauma Registry (ITR) in the surveillance of occupational injuries. The entire dataset of the ITR was obtained from the Illinois Department of Public Health for the years 1993 and 1994. The occupational injuries were extracted and frequency distributions were determined for all demographic and health variables. Background population, employment, and death-rate data were obtained for the purpose of rate calculation and for comparison of raw data. Mean costs for acute occupational injuries were calculated. There were 5844 occupational cases, comprising 6.7% of the total group. The majority of injuries had occurred in males (86%), in urban settings (81%), and were of the "blunt" injury type. External cause (coded according to the International Classification of Diseases, 9th Revision, External Injury) categories for work-related injuries were "Cut/Struck," 39%; "Falls," 36%; "Transportation," 12%; "Environmental," 6%; "Violence," 3%; and the remainder, 5%. By definition, all cases were admitted to the hospital, with 62% classified as "minor," 28% "moderate," and the remaining 11% "severe" to "life threatening." Surgery was performed in 54%, and admission to a monitored bed or the intensive care unit occurred in 15%. Although 93% were discharged home, only 54% ambulated independently. Seven percent were not independent with regard to self-feeding status. The mean hospital charge was $10,802 (standard deviation, $31,438). A pyramidal model of the place of ITR cases in the universe of occupational injuries is presented. The ITR contains a unique set of variables that broaden our understanding of serious work-related injuries. It is recommended that these variables--"occupation," "type of industry," and "nature of injury"--be added to the ITR so that it may be linked with other databases to check its validity and completeness and to enhance its value in occupational surveillance.