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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
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 Source
HOSPITALS/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*
Caucasian
African-American
Asian
Hispanic
Other
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%
YES
NO
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 TOTAL
Construction (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%)
individuals
21.9%
23.7%
23.7%
30.7%
Summer
Spring
Fall
Winter
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
100
114
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
