Use of multiple data sources for surveillance of work-related amputations in Massachusetts, comparison with official estimates and implications for national surveillance

[Medical-surgical complications and their impact on patients' return to work whilst follow-up major lower-limb amputations in Hospital del Trabajador in Santiago (HTS)]

INTRODUCTION

The presence of different complications whilst follow-up amputee patients reaches 10-80%. The main objective of this research is to assess the impact of these in the return-to-work of lower-limb traumatic amputation cases.

MATERIALS AND METHODS

A retrospective cohort research was carried out. Clinic-demographic variables information was recollected in order to assess its linkage to different medical-surgical complications and functional outcomes. Survival curves were created to evaluate the return-to-work of patients with and without complications.

RESULTS

A total of 46 patients, on average aged 45.7 years old (91.3% men, 71.7% without comorbidities), were included on this research. The most frequent level of amputation was transtibial (65.2%). Residual limb pain, phantom pain, dermatological-infectious complications and painful neuroma were registered in 80.4%, 58.7%, 50% y 30.4% of the cases respectively. Half of the patients had returned to their workplace after 2years of post-surgical follow-up. The return-to-work rates were significantly lower in patients suffering from residual limb pain (p=0.0083) and from painful neuroma (p=0.0051).

CONCLUSION

Complications are frequent during traumatic-amputee patients' follow-up and, some of them, may impact on the return-to-work rate.

Using a severity threshold to improve occupational injury surveillance: Assessment of a severe traumatic injury-based occupational health indicator across the International Classification of Diseases lexicon transition

BACKGROUND

Traumatic injury is a leading cause of death and disability among US workers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state-based occupational health indicator (OHI #22) was initiated in 2012 to track work-related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work-related hospitalizations.

METHODS

Seventeen states used hospital discharge data to calculate estimates for calendar years 2012-2019. State-panel fixed-effects regression was used to model linear trends in annual work-related hospitalization rates, OHI #22 rates, and the proportion of work-related hospitalizations resulting from severe injuries. Models included calendar year and pre- to post-ICD-10-CM transition.

RESULTS

Work-related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD-10-CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near-monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work-related hospitalizations before the ICD-10-CM transition, versus 9.1% post-transition.

CONCLUSIONS

Although hospital discharge data suggest decreasing work-related hospitalizations over time, work-related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD-10-CM transition-associated structural break in 2015.

Trends in incidence and correlation between medical costs and lost workdays for work-related amputations in the State of California from 2007 to 2018

BACKGROUND

Detailed information regarding workers who experience an amputation in the workplace over the last decade is limited. To better understand the financial and functional impact of a work-related amputation, this study quantifies the incidence of work-related amputations in the California workforce from 2007 to 2018 as well as the relationship between medical costs and lost workdays as a function of amputation level.

METHODS

Workers' compensation claims data from California spanning the years 2007 to 2018 were evaluated to describe trends in amputation incidence (N = 16 931). Quartile values for medical costs, indemnity costs, and lost workdays were reported as a function of amputation level. Correlations were performed between medical costs and lost workdays to examine their relationship.

RESULTS

The average incidence from 2007 to 2018 was 8.9 (95% CI 8.5, 9.4) amputations per 100 000 workers. There was a significant spike in amputations in 2008. Partial-hand amputations were the most common with 73.3 (95% CI 69.2, 77.7) cases per 1 000 000 workers, and the industry with the highest incidence was construction with 26.0 (95% CI 22.4, 30.0) cases per 100 000 workers. Overall, medical costs were moderately correlated with lost workdays (Spearman's rho = 0.51), and that level of correlation remained relatively consistent across all levels of amputation (Spearman's rho = 0.48-0.62).

CONCLUSIONS

Amputations represent high medical costs and number of lost workdays. Considering the type of amputation and the industry the injury occurred in is important in order to work toward returning this population to work. Our results present the status of amputations in the California workplace and establish a basis for using medical costs to infer lost work productivity for this population.

Multi-source surveillance for work-related crushing injuries

BACKGROUND

Work-related crushing injuries are serious but preventable. For 2013 through 2015, the U.S. Bureau of Labor Statistics' (BLS) Survey of Occupational Injuries and Illnesses (SOII) reported 1260 crushing injuries in Michigan. In 2013, Michigan initiated multi-data source surveillance of work-related crushing injuries.

METHODS

Records from all 134 of Michigan's hospitals/emergency departments (EDs), the Workers Compensation Agency (WCA) and Michigan's Fatality Assessment Control and Evaluation (MIFACE) program were used to identify work-related crushing injuries. Companies, where individuals were hospitalized or had an ED visit for a crushing injury, potentially had an OSHA enforcement inspection conducted.

RESULTS

From 2013 through 2015, there were 3137 work-related crushing injury incidents, including two fatalities. The Michigan OSHA program completed inspections at 77 worksites identified by the surveillance system.

CONCLUSION

The Michigan multisource surveillance system identified two and a half times more crushing injuries than BLS and was useful for initiating case-based enforcement inspections.

Same-level fall injuries in US workplaces by age group, gender, and industry

BACKGROUND

As the workforce ages, occupational injuries from falls on the same level will increase. Some industries may be more affected than others.

METHODS

We conducted a cross-sectional study using data from the Bureau of Labor Statistics to estimate same-level fall injury incidence rates by age group, gender, and industry for four sectors: 1) healthcare and social assistance; 2) manufacturing; 3) retail; and 4) transportation and warehousing. We calculated rate ratios and rate differences by age group and gender.

RESULTS

Same-level fall injury incidence rates increase with age in all four sectors. However, patterns of rate ratios and rate differences vary by age group, gender, and industry. Younger workers, men, and manufacturing workers generally have lower rates.

CONCLUSIONS

Variation in incidence rates suggests there are unrealized opportunities to prevent same-level fall injuries. Interventions should be evaluated for their effectiveness at reducing injuries, avoiding gender- or age-discrimination and improving work ability.

Evaluation of a state based syndromic surveillance system for the classification and capture of non-fatal occupational injuries and illnesses in New Jersey

BACKGROUND

This preliminary study evaluates a real-time syndromic surveillance system to track occupationally-related emergency room visits throughout New Jersey.

METHODS

Emergency Department (ED) chief complaint fields were evaluated from 79 of 80 hospitals in NJ in 2014, using work-related keywords and ICD-9 E-codes, to determine its ability to capture non-fatal work-related injuries. Sensitivity analysis and descriptive statistics, were used to evaluate and summarize the occupational injuries identified.

RESULTS

Overall, 11 919 (0.3%) possible work-related ED visits were identified from all ED visits. Events with the greatest number of ED visits were slips, trips, and falls (1679, 14%). Nature of injury included cuts, lacerations (1041, 9%). The part of the body most affected was the back (1414, 12%). This work-related classifier achieved a sensitivity of 5.4%, a specificity of 99.8%, and a PPV of 2.8%.

CONCLUSIONS

This evaluation demonstrated that the syndromic surveillance reporting system can yield real-time knowledge of work-related injuries.

Impact of Occupational Injuries on Nonworkers' Compensation Medical Costs of Patient-Care Workers

OBJECTIVE

The aim of this study was to estimate the extent to which work-related injuries contribute to medical expenditures paid for by group health insurance.

METHODS

Administrative data on OSHA recordable injuries spanning 2010 to 2013 were obtained for female patient care workers (n = 2495). Expenditures were aggregated group health insurance claims for 3 and 6-month periods before/after injury. Group health insurance plan type, age group, and job category were control variables.

RESULTS

Being injured is associated with the odds of having expenditures at both 3 months, odds ratio (OR) 2.17 [95% confidence interval (95% CI) 1.61 to 2.92], and 6 months, 2.95 (95% CI 1.96 to 4.45). Injury was associated with $275 of additional expenditures (95% CI $38 to $549) over 3 months and $587 of additional expenditures (95% CI $167 to $1140) over 6 months.

CONCLUSIONS

Injury was associated with increased odds of positive expenditures and increased expenditures paid for by group health insurance.

The Impact of Contract Operations on Safety in Underground Coal Mines

OBJECTIVE

The aim of this study was to test for differences in injury rates for contractor-operated underground coal mines relative to owner-operated mines in Kentucky, controlling for other covariates.

METHODS

We used disparities between MSHA contractor data and surface reclamation permit data to identify mines operated by contractors. We then used negative binomial regression to estimate injury rates from 1999 to 2013, controlling for mine and controller characteristics available from MSHA and the Energy Information Administration (EIA).

RESULTS

Contractor-operated mines with 15 or fewer full-time equivalent workers (FTEs) had a statistically significant 57% higher covariate-adjusted reported traumatic injury rate than similar mines without contract operators. Larger contractor-operated mines did not have a statistically significant elevated rate.

CONCLUSIONS

We detected a significant elevation of traumatic injury rates only among the smallest contractor-operated mines. This increase appears substantial enough to warrant attention.

Employer reasons for failing to report eligible workers' compensation claims in the BLS survey of occupational injuries and illnesses

Background

Little research has been done to identify reasons employers fail to report some injuries and illnesses in the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII).

Methods

We interviewed the 2012 Washington SOII respondents from establishments that had failed to report one or more eligible workers’ compensation claims in the SOII about their reasons for not reporting specific claims. Qualitative content analysis methods were used to identify themes and patterns in the responses.

Results

Non‐compliance with OSHA recordkeeping or SOII reporting instructions and data entry errors led to unreported claims. Some employers refused to include claims because they did not consider the injury to be work‐related, despite workers’ compensation eligibility. Participant responses brought the SOII eligibility of some claims into question.

Conclusion

Systematic and non‐systematic errors lead to SOII underreporting. Insufficient recordkeeping systems and limited knowledge of reporting requirements are barriers to accurate workplace injury records. Am. J. Ind. Med. 59:343–356, 2016. © 2016 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

Work-Related Unintentional Injuries Associated With Hurricane Sandy in New Jersey

OBJECTIVE

We aimed to evaluate the occurrence of work-related injuries after Hurricane Sandy potentially related to response and recovery.

METHODS

Emergency and hospital discharges (patients aged 18-65 years) with a diagnosis of unintentional injury were obtained from the New Jersey Department of Health. Work-related injuries were identified as those with a workers' compensation payer or other work-related codes. Counties were categorized as high-, medium-, or low-impact areas. Poisson regression analysis was used to compare the rate of work-related injury the year following Sandy landfall with the 3 previous years.

RESULTS

Total work-related injuries declined the week immediately after Sandy (rate ratio [RR]: 0.85; 95% confidence interval [CI]: 0.69-1.05) and no overall increase was found in the year after Hurricane Sandy. However, high-impact counties showed an elevated risk of work-related injuries in the first and third quarters after Hurricane Sandy among men, especially for blacks and Hispanics. The greatest excesses occurred in the third quarter after the storm, May to July, for falls (RR: 1.30; 95% CI: 1.08-1.57), cut/pierce injuries (RR: 1.24; 95% CI: 1.09-1.40), struck-by injuries (RR: 1.17; 95% CI: 1.02-1.34), and overexertion (RR: 1.26; 95% CI: 1.10-1.44).

CONCLUSIONS

Hospital data suggested an increase in injuries associated with rebuilding and recovery rather than with initial response. Future efforts aimed at prevention should evaluate the mechanisms and circumstances of injury in more detail. (Disaster Med Public Health Preparedness. 2016;10:394-404).

The direct cost burden of 13years of disabling workplace injuries in the U.S. (1998-2010): Findings from the Liberty Mutual Workplace Safety Index

INTRODUCTION

Although occupational injuries are among the leading causes of death and disability around the world, the burden due to occupational injuries has historically been under-recognized, obscuring the need to address a major public health problem.

METHODS

We established the Liberty Mutual Workplace Safety Index (LMWSI) to provide a reliable annual metric of the leading causes of the most serious workplace injuries in the United States based on direct workers compensation (WC) costs.

RESULTS

More than $600 billion in direct WC costs were spent on the most disabling compensable non-fatal injuries and illnesses in the United States from 1998 to 2010. The burden in 2010 remained similar to the burden in 1998 in real terms. The categories of overexertion ($13.6B, 2010) and fall on same level ($8.6B, 2010) were consistently ranked 1st and 2nd.

PRACTICAL APPLICATION

The LMWSI was created to establish the relative burdens of events leading to work-related injury so they could be better recognized and prioritized. Such a ranking might be used to develop research goals and interventions to reduce the burden of workplace injury in the United States.

Developing Surveillance Methodology for Agricultural and Logging Injury in New Hampshire Using Electronic Administrative Data Sets

OBJECTIVE

Agriculture and logging rank among industries with the highest rates of occupational fatality and injury. Establishing a nonfatal injury surveillance system is a top priority in the National Occupational Research Agenda. Sources of data such as patient care reports (PCRs) and hospitalization data have recently transitioned to electronic databases.

METHODS

Using narrative and location codes from PCRs, along with International Classification of Diseases, 9th Revision, external cause of injury codes (E-codes) in hospital data, researchers are designing a surveillance system to track farm and logging injury.

RESULTS

A total of 357 true agricultural or logging cases were identified.

CONCLUSIONS

These data indicate that it is possible to identify agricultural and logging injury events in PCR and hospital data. Multiple data sources increase catchment; nevertheless, limitations in methods of identification of agricultural and logging injury contribute to the likely undercount of injury events.

Understanding the hospital sharps injury reporting pathway

BACKGROUND

Patient-care workers are frequently exposed to sharps injuries, which can involve the risk of serious illness. Underreporting of these injuries can compromise prevention efforts.

METHODS

We linked survey responses of 1,572 non-physician patient-care workers with the Occupational Health Services (OHS) database at two academic hospitals. We determined whether survey respondents who said they had sharps injuries indicated that they had reported them and whether reported injuries were recorded in the OHS database.

RESULTS

Respondents said that they reported 62 of 78 sharps injuries occurring over a 12-month period. Only 28 appeared in the OHS data. Safety practices were positively associated with respondents' saying they reported sharps injuries but not with whether reported injuries appeared in the OHS data.

CONCLUSIONS

Administrators should consider creating reporting mechanisms that are simpler and more direct. Administrators and researchers should attempt to understand how incidents might be lost before they are recorded.

Work-related concussion surveillance

BACKGROUND

The goal of this study was to use multiple state-based data sources (emergency department [ED] visits, hospital discharge [HD] data, and workers' compensation [WC] data) to estimate the 2011 work-related concussion injury rate in Kentucky.

METHODS

Deterministic data linkages between the 2011 WC data and ED/HD data were performed. Annual crude rates of work-related concussions per 100,000 employed civilians age 16 years or older were reported.

RESULTS

Using the three data sources, the 2011 work-related concussion crude rate was 31.8/100,000, higher for men (38.8/100,000) than for women (24.1/100,000). The use of WC data alone resulted in an estimated rate of only 11.7/100,000. ED data utilization alone resulted in a rate of 21.7/100,000.

CONCLUSION

This study's primary recommendation is to use WC, ED, and HD data on a routine basis as part of multiple data source surveillance for work-related concussion injuries.