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

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.

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

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

Work-Related SF Reporting Sources Hospitals/Emergency Departments (ED)

Workers’ Compensation Agency (WC)

Michigan Fatality Assessment and Control Evaluation (MIFACE)

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)

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)

Work-Related SF Reporting Sources cont. Michigan Fatality Assessment and Control

Evaluation (MIFACE)

Skull fracture as a primary or secondary cause of death.

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.

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).

2010 Michigan Reports – By SourceHOSPITALS/EDs (91)

100

46 BLS

3 411

3 1 19

MIFACE (8) WCA (62)Number of Individuals: 114

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)

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”

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”

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

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%

Loss of Consciousness, Michigan 2010 Loss of consciousness specified: 85

(74.6%) individuals

45.9%

54.1%

YESNO

Part of Skull Injured by ICD-9 code, Michigan 2010

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%

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.

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%

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%

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

Seasonality of Injury, Michigan 2010 Season of injury specified: 114 (100%)

individuals21.9%

23.7%

23.7%

30.7%SummerSpringFallWinter

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

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.

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.

MIOSHA Enforcement Inspections

MIOSHA referral criteria: 2010 Hospitalization Within past 6 months All NAICS codes

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.

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

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

THANK YOUQuestions?

kica@msu.eduwww.oem.msu.edu