multi-source surveillance system for work-related skull fractures in michigan
DESCRIPTION
Multi-Source Surveillance System for Work-Related Skull Fractures in Michigan. Joanna Kica, MPA Kenneth D. Rosenman, MD Department of Medicine Occupational and Environmental Medicine Michigan State University. Background. - PowerPoint PPT PresentationTRANSCRIPT
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Multi-Source Surveillance System for Work-Related Skull Fractures in Michigan
Joanna Kica, MPAKenneth D. Rosenman, MD
Department of MedicineOccupational and Environmental MedicineMichigan State University
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Background
Nationally, BLS reported 3,850 SF in 2010. This corresponds to a rate of 0.4 per 10,000 workers.
BLS reported 100 cases for MI for 2010. This corresponds to a rate of 0.01 per 10,000 workers.
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Background
All Traumatic injuries are reportable in Michigan
Surveillance of work-related skull fractures to: Identify demographics, industries Understand magnitude and extent Intervene and prevent similar injuries
2010 – First year of compiling occupational skull fractures (SF) data
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Background MDCH
Promulgated reporting rule MSU Occupational & Environmental
Medicine Receives reports Confirms work-related SF diagnoses Summarizes information learned from
surveillance Develops prevention strategies Case referral to MIOSHA
MIOSHA Work place enforcement investigations of
referred cases
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Work-Related SF Reporting Sources Hospitals/Emergency Departments (ED)
Workers’ Compensation Agency (WC)
Michigan Fatality Assessment and Control Evaluation (MIFACE)
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Work-Related SF Reporting Sources cont.
ICD-9* 800 – Fracture of vault of
skull 801 – Fracture of base of
skull 803 – Other and
unqualified skull fractures 804 – Multiple fractures
involving skull or face with other bones
*ICD-9 code: 802 (Fracture offace bones) was not
requested.
ICD-10 codes S01 – Open wound of
head S02 – Fracture of skull and
facial bones S07 – Crushing injury to
head T02 – Fractures involving
head with neck T04 – Crushing injuries
involving head with neck
Hospitals/Emergency Departments (ED)
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Work-Related SF Reporting Sources cont. Workers’ Compensation Agency (WC) Nature of Injury code: Fracture Part of Body description: - Brain (0) - Head, unspecified (5)- Cheek/Chin/Jaw (3) - Mandible (0)- Concussion (0) - Scalp (0)- Face, multiple parts (1) - Sinus (0)- Face, not elsewhere specified (0) - Skull (8)- Face, unspecified (5)- Forehead (1)- Head, multiple (1)
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Work-Related SF Reporting Sources cont. Michigan Fatality Assessment and Control
Evaluation (MIFACE)
Skull fracture as a primary or secondary cause of death.
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Definition of Skull Fracture
Skull fracture is a crack or break in the cranial (skull) bones. It may be accompanied by injury to the brain.
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Summary Statistics, Michigan 2010 114 individuals sustained work-related SF* 7 self-employed individuals 8 fatalities Types of medical encounters:
Hospitalizations – 54 (47.4%) ED visits – 34 (29.8%) Outpatient visits – 3 (2.6%) Unknown – 23 (20.2%)
*One hospital has still to report (estimated another 1-2 reports).
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2010 Michigan Reports – By SourceHOSPITALS/EDs (91)
100
46 BLS
3 411
3 1 19
MIFACE (8) WCA (62)Number of Individuals: 114
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Workers’ Compensation Data, Michigan 2010
26,583 MI WC paid claims for work-related injuries and illnesses with 7 consecutive days away from work
62 (0.002%) cases identified as work-related SF (there were additional 19 nasal fractures that were not included in our total)
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62 Paid WC Claims – A Closer Look….. 24 where injury description was “Fracture”
5 matched hospital/ED records 19 did not match hospital/ED and MIFACE
38 matched hospital/ED or MIFACE records by name, date of birth, date of injury and employee’s zip code and had injury description as something other than “Fracture of skull”
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38 WC with Non Fracture Descriptions that Matched Hospital /ED Skull Fractures 13 “Multiple Injuries” 9 “Fracture” (other than skull) 5 “Concussion” 5 “Cut/Laceration” 2 “Unclassified” 1 “Amputation” 1 “Crush/Contusion” 1 “Ill-Defined” 1 “Strains/Sprains”
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Worker Demographics, Michigan 2010
Males: 95 (83.3%)
Average Age: 43 Age range: 17-75
*Race available only for 50.9% of all individuals.
84.5%
5.2%
1.7% 5.2%3.4%
Race*
CaucasianAfrican-AmericanAsianHispanicOther
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Cause of Injury, Michigan 2010
Cause of injury specified: 95 (83.3%) individuals
Machine
MVA
Assault
Medical Condition
Struck By
Fall
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
1.1%
5.3%
6.3%
7.4%
34.7%
45.3%
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Loss of Consciousness, Michigan 2010 Loss of consciousness specified: 85
(74.6%) individuals
45.9%
54.1%
YESNO
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Part of Skull Injured by ICD-9 code, Michigan 2010
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Part of Skull Injured, Michigan 2010 Part of skull specified: 114 (100%)
individuals
Multiple (ICD-9: 804)
Face Multiple
Jaw/Chin/Cheek
Face Unspecified
Vault (ICD-9: 800)
Other and Unqualified (ICD-9: 803)
Base (ICD-9: 801)
0% 10% 20% 30% 40% 50% 60% 70%
0.9%
0.9%
2.6%
4.4%
10.5%
18.4%
62.3%
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Type of Skull Fracture, Michigan 2010 Compound Skull Fracture – is a break in, or loss of, skin
and splintering of the bone. Linear Skull Fracture – is a break in a cranial bone
resembling a thin line, without splintering or depression of bone.
Displaced Skull Fracture – is a break of the bone into two or more parts and displacement of the bone so that the two ends are not lined up straight.
Depressed Skull Fracture – is a break in the cranial bone with depression of the bone in toward the brain.
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Type of Injury, Michigan 2010
Type of fracture specified: 25 (21.9%) individuals
Compound Fracture
Linear Fracture
Displaced Fracture
Depressed Fracture
0% 10% 20% 30% 40% 50% 60% 70%
4.0%
8.0%
24.0%
64.0%
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Industry of Skull Fracture, Michigan 2010
Sufficient information for industry classification: 105 (92.1%) individuals
Industry Classification (NAICS) Number Percent Construction (23) 14 13.3 Primary Metal Manufacturing (33) 11 10.5% Public Administration (92) 9 8.6% Transportation and Warehousing (48) 8 7.6% Health Care and Social Assistance (62) 8 7.6% Educational Services (61) 7 6.7% Agriculture, Forestry, Fishing and Hunting (11) 6 5.7% Retail Trade (44) 6 5.7% Accomodation and Food Services (72) 6 5.7% Admin. and Support and Waste Mgt and Remediation Svcs (56) 6 5.7% Wood Product Manufacturing (32) 5 4.8% Wholesale Trade (42) 4 3.8% Finance and Insurance (52) 3 2.9% Utilities (22) 3 2.9% Real Estate and Rental and Leasing (53) 2 1.9% Professional, Scientific and Technical Services (54) 2 1.9%Food Manufacturing (31) 2 1.9% Sporting Goods, Hobby, Book and Music Stores (45) 1 1.0% General Warehousing and Storage (49) 1 1.0% Information (51) 1 1.0%Total 105 100.0%
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Top 5 Industries by Cause of Injury, Michigan 2010
INDUSTRY (ICD-9 code) Struck By Fall Assault MVA Med. Cond. Unknown TOTALConstruction (23) 2 9 0 1 0 2 14Primary Metal Manufacturing (33) 5 3 0 0 2 1 11Public Administration (92) 4 0 1 0 1 3 9Transportation and Warehousing (48) 4 1 1 1 0 1 8Health Care and Social Assistance (62) 1 3 0 0 0 4 8
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Seasonality of Injury, Michigan 2010 Season of injury specified: 114 (100%)
individuals21.9%
23.7%
23.7%
30.7%SummerSpringFallWinter
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WC as Source of Payment, Michigan 2010
WC DATABASE YES NO TOTAL
Yes, as Skull Fracture 22 2 24Yes, as Other Description 27 11 38No 22 30 52
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Skull Fracture Injury Narrative Examples, Michigan 2010 A 19-year-old male slipped on a wet floor and fell hitting the left side
of his head against the metallic prongs of a forklift; he lost consciousness and sustained a depressed skull fracture.
A 27-year-old male fell 12 feet from a hydraulic basket when the machine fell over. He hit his head against a railing.
A 44-year-old female was hit in the head by a one gallon can that fell off the shelf.
A 40-year-old male fell off a roof while cleaning gutters; he lost consciousness and sustained subarachnoid hemorrhage.
A 53-year-old male fell 10-15 feet from the top of a semi truck; he lost consciousness and sustained multiple facial fractures.
A 17-year old male was hit in the head by a steel pipe; he sustained a depressed skull fracture.
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Skull Fracture Fatality Narratives, Michigan 2010
A 75-year-old farmer was run over by a tractor after he had started the tractor while standing next to it. He sustained skull fracture with subdural hematoma.
A 54-year-old police officer was assisting a motorist on a freeway when was struck by a hit and run motor vehicle. He sustained several injuries including an open skull fracture.
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MIOSHA Enforcement Inspections
MIOSHA referral criteria: 2010 Hospitalization Within past 6 months All NAICS codes
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MIOSHA Enforcement Inspections, 2010 2 Enforcement Inspections (fatal)
Wood Product Manufacturing Violation: Employer did not notify MIOSHA of a workplace
fatality within 8 hours.
General Warehousing and Storage Violation: Employer did not notify MIOSHA of a workplace
fatality within 8 hours.
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Comparison of Different Data Surveillance Systems BLS – 100 (includes nasal fractures) WC – 43 (includes nasal fractures) MI multisource – 114 (excludes nasal fractures)
WC BLS MI multisource0
20
40
60
80
100
120
43
100114
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Summary
Lessons learned, future directions: Quarterly hospital reporting since 2011 More timely work place interventions More work place interventions ICD-9 code: 802 (Fracture of face bones) being
reported by hospitals/EDs since 2012 Educational materials