Work related traumatic brain injury due to assault

Tatyana Mollayeva, MD, PhD (cand)

Co-authors and funding

Co-authors:

Shirin Mollayeva, BSc (cand), John Lewko, PhD, Angela Colantonio, PhD

Funding:

Disclosure The authors have no conflict of interest to disclose

Traumatic brain injury: definition

“an alteration in brain function, or other evidence of brain pathology, caused by an external force”1

1Brain Injury Association of America. About Brain Injury. 2011. Retrieved June 10, 2012, from http://www.biausa.org/about-brain-injury.htm.

Background ≈628,000 Canadians live w/ brain injury-related disability1

Over 50% are under 20 years of age1

Most traumatic brain injury (TBI) causes preventable (e.g. falls, motor vehicle accidents, assaults)

TBIs at work (wrTBI) may differ in patterns and risks from injuries outside the workplace2,3

wrTBIs, 1993-2001: 3.6% assault-related, likely underestimate4

Occupational Health and Safety Act wrt workplace violence5 - assault at work a broad public health concern

Physical and psychological effects severe, assoc. with great financial loss6

1. NHCC and BIAC Election messaging. (2011, 3 29). Retrieved 04 04, 2014, from Brain injury Association of Canada: http://biac-aclc.ca/2011/03/29/nhcc-and-biac-election-messaging/.

2. Workplace Safety and Insurance Board’s (WSIB) 2005 Annual Report. Retrieved 01 01,2014, from http://www.wsib.on.ca/files/Content/Downloadable%20File2005StatisticalSupplement/2278A_StatSup.pdf

3. Colantonio A, Mroczek D, Patel J, Lewko J, Fergenbaum J, Brison R. Examining occupational traumatic brain injury in Ontario. Can J Pub Health. 2010; 101: S58-62.4. Kim H, Colantonio A, Chipman M. Traumatic brain injury occuring at work. Neurorehabil, 2006; 21: 269-278.5. Canadian Centre for Occupational Health and Safety Act. Retrieved 4 11, 2013, from http://www.gov.pe.ca/law/statutes/pdf/o-01_01.pdf.

Gap in knowledge and study objectives Despite evidence for risks of work-related assault, data on

wrTBI due to assault in Canada is lacking

Objectives: Assess extent of assault resulting in TBI by sex, across

occupational sectors in Ontario Examine related demographic and workplace

characteristics Provide better understanding of circumstances of

incidents

Data collection Case series design, examined all claims with 2004 injury

date and categorized as “intracranial injury” or “concussion”, also examined “traumatic” fatalities

1,006 files met criteria, positive identification of TBI; accepted only with confirmed diagnosis by physician of “concussion”, “closed head injury”, “contusion”, “head injury with sequelae consistent with brain injury”1

Qualitative and qualitative data analyses

1. Colantonio A, Mrockzek D, Patel J, Lewko J, Fergenbaum J, Brison R. Examining occupational traumatic brain injury. Can J of Public Health. 2010; 101(2): S58-62.

Variables Socio-demographic (i.e. sex, age, occupation type/sector,

years employed) Injury-related (i.e. mechanism of injury, shift worked,

date/time of injury, day of week) Event summaries to categorize cases by type and source

of aggression

Data analysis Frequency distributions, central dispersion for demographic

and injury variables Denominator: Statistics Canada 2004 data on employment,

by sex1

Case categorization:2

Type 1: external/intrusive violence (assailants have no relationship to workplace)

Type 2: consumer/client related offence (related to interaction w/ customer/patient/student)

Type 3: relationship violence (assailant a co-worker or partner)

Type 4: organizational violence (assault premeditated, carried out by coordinated force/group of people)

1. Government of Canada. Economic Data Tables. Retrieved 3 11, 2013, from Statistics Canada: Employment by age, sex, type of work, class of worker and province (monthly): http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/labr66g-eng.htm.

2. Bowie V. Workplace Violence. New South Wales: Work Cover; 2002.

Results

Demographic characteristics

66

1006

wrTBI claims (n), by cause

injury due to physical assault

injury not due to physical assault

39

27

wrTBI (n) due to assault, by sex

Female

Male

Age range=20-64 (median 37 y.o.) ≈assault-related wrTBI claim

rate=9.85/1 million Ontario employees

Claim rate for women≈11.79/1 mil Ontario workers; men≈8.4/1 mil

Frequency of wrTBI caused by physical assault greater in female employees (59.1%), higher than that for all TBI cases of all mechanisms (42.3%)

Demographic characteristics

health care aides, 27

police/guards/security/law en-

forcement/public administra-tion personnel, 22

education sector; 10

other (mostly drivers); 8

Physical assault-related wrTBIs (n), by occupation

Sex differences within sectors

Health care/social services sector: Rate of wrTBI six-fold higher for female

workers

Education sector: Rate of wrTBI four-fold higher for female

workers

Police/guard/law enforcement sector: Rate of wrTBI 13-fold higher for male

workers

Work experience

<3 yrs46%

4-9 yrs21%

>10 yrs23%

>20 yrs6%

NR5%

wrTBI, by years employed

43% employed <1 year

Temporal characteristics

Highest number of TBIs due to assault in 2004 occurred in March and November

Weekly peaks – Mondays and Fridays Most injuries occurred in late morning

and early afternoon

Type 1 (external/instrusive)

21%

Type 2 (consumer/client-

related)71%

Types 3/4 (relationship/or-ganizational)

8%

Assault types

Event-related characteristics

Images: Yow Canada Inc.

Event-related characteristics >40% of assaults resulting in wrTBI occurred in one-

on-one interactions with clients; >1/3 - dealing with irate/angry clients

23% - attempts to restrain/follow suspicious individuals 12% - dealing with disabled/special needs individuals

or those with awareness issues 7% - in mobile workplaces (i.e. taxi, bus, etc.) Sex differences: additional injuries to other body parts

(e.g. neck, arms, etc.) – more in women (79%)

Cost of claimsReturn to work by end of data col-

lection23%

No return to work before data col-

lection completion77%

10 female and 5 male workers

75% off work for >2 months

Total days of disability=8,953 Women accrued more

disability days compared to men (5,166 vs. 3,787)

Limitations Estimates yielded conservative as approximately 70%

of Ontario workers are insured by WSIB

Remaining 30% may not have similar characteristics

wrTBI due to assault examined for a period of one year only; a longer period of time is needed to understand the full scope of the mechanism of wrTBI

Implications for prevention Workers with less experience (i.e. <3 years

employed) overrepresented: training promoting awareness of workplace assault, testing on ability to identifying risks prior to release to independent duty.

Working with persons with cognitive and/or mental health challenges: conflict management, empathy, training to predict and react to aggression

One-on-one with client: self-defense, working in pairs Guarding property, following suspect: restraint

and self-defense training Mobile workplace: training to recognize potentially

threatening situations, client awareness of zero tolerance policy for aggression and assault toward workers

Conclusions First paper examining wrTBI

due to assault; representative sample of workers; focus on sex

wrTBI due to assault across industries and types of physical aggression

Results can serve as a basis for further wrTBI surveillance work; stimulate development of appropriate control efforts in work-related assault

Thank you!