The burden of traumatic brain injury among adolescent and young adult workers in Washington State

ObjectiveThis study describes injury characteristics and costs of work-related traumatic brain injury (WRTBI) among 16-24 year olds in Washington State between 1998 and 2008.MethodsWRTBIs were identified in the Washington Trauma Registry (WTR) and linked to workers' compensation (WC) claims data. Medical and time-loss compensation costs were compared between workers with isolated TBI and TBI with other trauma.ResultsOf 273 WRTBI cases identified, most (61.5%) were TBI with other trauma. One-third of WRTBI did not link to a WC claim. Medical costs averaged $88,307 (median $16,426) for isolated TBI cases, compared to $73,669 (median $41,167) for TBI with other trauma.ConclusionsResults highlight the financial impact of WRTBI among young workers. Multiple data sources provided a more comprehensive picture than a single data source alone. This linked-data approach holds great potential for future traumatic occupational injury research.Impact on IndustryTBI among young workers not only involves long-term health and psychological impacts, but is costly as well.     

Characteristics of construction firms at risk for future workers' compensation claims using administrative data systems,Washington State

Introduction: Construction is high-hazard industry, and continually ranks among those with the highest workers' compensation (WC) claim rates in Washington State (WA). However, not all construction firms are at equal risk. We tested the ability to identify those construction firms most at risk for future claims using only administrative WC and unemployment insurance data. Methods: We collected information on construction firms with 10–50 average full time equivalent (FTE) employees from the WA unemployment insurance and WC data systems (n = 1228). Negative binomial regression was used to test the ability of firm characteristics measured during 2011–2013 to predict time-loss claim rates in the following year, 2014. Results: Claim rates in 2014 varied by construction industry groups, ranging from 0.7 (Land Subdivision) to 4.6 (Foundation, Structure, and Building Construction) claims per 100 FTE. Construction firms with higher average WC premium rates, a history of WC claims, increasing number of quarterly FTE, and lower average wage rates during 2011–2013 were predicted to have higher WC claim rates in 2014. Conclusions: We demonstrate the ability to leverage administrative data to identify construction firms predicted to have future WC claims. This study should be repeated to determine if these results are applicable to other high-hazard industries. Practical Applications: This study identified characteristics that may be used to further refine targeted outreach and prevention to construction firms at risk.     

Prioritizing prevention opportunities in the Washington State construction industry, 2003-2007

Objective

This study compares construction industry groups in Washington State by injury severity and cost, and ranks industry groups according to potential for prevention.

Methods

All Washington State workers' compensation compensable claims with date of injury between 2003 and 2007 were classified into North American Industrial Classification System (NAICS) industry groups. Claims were then aggregated by injury type and industry groups were ranked according to a prevention index (PI). The PI is the average of the rank orders of the claim count and the claim incidence rate. A lower PI indicates a higher need for prevention activities. The severity rate was calculated as the number of days of time loss per 10,000 full-time equivalents (FTEs).

Results

For all injury types, construction industry groups occupy 7 of the top 15 PI ranks in Washington State. The severity rate among construction industry groups was twice that for non-construction groups for all injury types. Foundation, structure, and building exterior contractors (NAICS 2381) ranked highest in prevention potential and severity among construction industry groups for most common injury types including falls from elevation, fall on same level, struck by/against, and musculo-skeletal disorders of the neck, back, and upper extremity (WMSDs). Median claim costs by injury type were generally higher among construction industry groups.

Conclusions

The construction industry in Washington State has a high severity rate and potential for prevention. The methods used for characterizing these industry groups can be adapted for comparison within and between other industries and states.

Impact on Industry

These data can be used by industry groups and employers to identify higher cost and higher severity injury types. Knowledge about the relative frequencies and costs associated with different injury types will help employers and construction industry associations make better informed decisions about where prevention efforts are most needed and may have the greatest impact. The results of this study can also be used by industry stakeholders to cooperatively focus on high cost and high severity injuries and explore best practices, interventions, and solutions as demonstrated by efforts to prevent musculoskeletal disorders in masonry (Entzel, Albers, & Welch, 2007). Initiating construction industry groups to focus on high cost and high severity injuries may also help prevent other types of injuries.     

The contribution of traumatic brain injury to the medical and economic outcomes of motor vehicle-related injuries in Ohio

Objective

To describe traumatic brain injury (TBI) among injured roadway users. Aim 1 assessed the association of age, gender, alcohol/drug use, safety equipment use, type of roadway user, metropolitan area, and primary payer with motor vehicle-related TBI outcome. Aim 2 assessed the relationship of motor vehicle-related TBI and risk/protective factors with medical and economic outcomes.

Methods

Population-level hospital and trauma databases from the Ohio Hospital Association and Ohio Department of Public Safety, respectively, were probabilistically linked for 2003 through 2006. Injured roadway users (motor vehicle occupants, motorcyclists, bicyclists, pedestrians, and others) were assessed for TBI, ventilator use, intensive care unit (ICU) admission, injury severity score (ISS), need for rehabilitation, death, and total hospital charges.

Results

The odds of a motor vehicle-related TBI were greater among those not using safety equipment (OR = 1.56). The interactions of alcohol/drug use by gender and of alcohol/drug use by location were significant. Sustaining a TBI increased the odds of requiring ventilation (OR = 3.66), being admitted to the ICU (OR = 2.51), having a high ISS (OR = 4.24), requiring rehabilitation (OR = 2.22), or death (OR = 2.52). When compared with a non-TBI, total hospital charges increased by a factor of 1.35 for a TBI. Hospital charges were $46,441 on average for individuals who sustained a TBI, whereas mean hospital charges were $32,614 for patients with a non-TBI.

Conclusions

Among injured roadway users, individuals who sustain a TBI are more likely to require extensive medical care and have injuries resulting in death.

Impact on industry

Prevention strategies aimed at reducing alcohol use and increasing safety device use should be encouraged to reduce the burden of TBI.     

Effect of loss control service on reported injury incidence

INTRODUCTION: A retrospective analysis evaluated the effectiveness of an insurance carrier's flexible loss control service strategy in reducing workers' compensation policyholders' reported injury and illness claims. OBJECTIVES: To assess the effects of a loss control service strategy on workers' compensation claim frequency rates, on medical-only claim rates, on severity-claim rates, and on claim cost among a group of California employers. METHODS: Eighty-two small- and medium-sized companies with workers' compensation policies expiring in 1999 were randomly selected from a population of policyholders assigned to loss control consultants for two or more years. Claim performance data were obtained for each company's first expired in-force policy year and its 1999 expired policy year. The retrospective design was combined with a control component based on a randomly selected comparison group of 45 companies whose first policy year with the insurer expired in 1999 and who received safety services from the loss control staff. RESULTS: The flexible loss control consultation service strategy was associated with lower average claim rates and costs. Companies assigned to a loss control consultant for two or more years (the "outcome group") had an average claim rate of 1.24 per $10,000 premium, compared with a rate of 1.62 in the "initial group" and a rate of 1.60 in the "comparison group." The average severity-claim rate of the outcome group was 0.32, compared with the initial-year and comparison-group means of 0.48 and 0.46, respectively. The average medical-only claim rate was 0.92, compared with the initial- and comparison-group means of 1.14 and 1.14. The outcome group's average loss ratio was over 10% lower than that of the initial and comparison groups. Statistical analysis indicated that differences among the groups' claim rates and severity-claim rates were [F=(2,206) 4.938, P=0.008] and [F=(2,206) 8.208, P<0.001], respectively. CONCLUSIONS: A loss control service strategy that provides service flexibility and develops partnership between employer and consultant can help reduce the frequency and severity of workers' compensation claims. Barriers to consultation service flexibility, both internal and external, should be identified and removed to enhance service efficacy.     

Work environment risk factors for injuries in wood processing

Problem

The reported injury rate for wood product manufacturing in Maine, 1987-2004, was almost twice the state-wide average for all jobs. Method: A case-control study was conducted in wood processing plants to determine preventable risk factors for injury. A total of 157 cases with injuries reported to workers' compensation and 251 controls were interviewed. Results: In multivariable analyses, variables associated with injury risk were high physical workload, machine-paced work or inability to take a break, lack of training, absence of a lockout/tagout program, low seniority, and male gender. Different subsets of these variables were significant when acute incidents and overexertions were analyzed separately and when all injuries were stratified by industry sub-sector. Impact on industry: Generalizability may be limited somewhat by non-representative participation of workplaces and individuals. Nevertheless, these findings provide evidence that many workplace injuries occurring in wood processing could be prevented by application of ergonomics principles and improved work organization.     

Workers’ compensation claim counts and rates by injury event/exposure among state-insured private employers in Ohio, 2007–2017

Introduction: This study analyzed workers’ compensation (WC) claims among private employers insured by the Ohio state-based WC carrier to identify high-risk industries by detailed cause of injury. Methods: A machine learning algorithm was used to code each claim by U.S. Bureau of Labor Statistics (BLS) event/exposure. The codes assigned to lost-time (LT) claims with lower algorithm probabilities of accurate classification or those LT claims with high costs were manually reviewed. WC data were linked with the state’s unemployment insurance (UI) data to identify the employer’s industry and number of employees. BLS data on hours worked per employee were used to estimate full-time equivalents (FTE) and calculate rates of WC claims per 100 FTE. Results: 140,780 LT claims and 633,373 medical-only claims were analyzed. Although counts and rates of LT WC claims declined from 2007 to 2017, the shares of leading LT injury event/exposures remained largely unchanged. LT claims due to Overexertion and Bodily Reaction (33.0%) were most common, followed by Falls, Slips, and Trips (31.4%), Contact with Objects and Equipment (22.5%), Transportation Incidents (7.0%), Exposure to Harmful Substances or Environments (2.8%), Violence and Other Injuries by Persons or Animals (2.5%), and Fires and Explosions (0.4%). These findings are consistent with other reported data. The proportions of injury event/exposures varied by industry, and high-risk industries were identified. Conclusions: Injuries have been reduced, but prevention challenges remain in certain industries. Available evidence on intervention effectiveness was summarized and mapped to the analysis results to demonstrate how the results can guide prevention efforts. Practical Applications: Employers, safety/health practitioners, researchers, WC insurers, and bureaus can use these data and machine learning methods to understand industry differences in the level and mix of risks, as well as industry trends, and to tailor safety, health, and disability prevention services and research.     

Work-related injuries among commercial janitors in Washington State,comparisons by gender

IntroductionWe analyzed workers' compensation (WC) data to identify characteristics related to workers' compensation claim outcomes among janitorial service workers in Washington State.MethodWe analyzed WC data from the Washington State Department of Labor & Industries (L&I) State Fund (SF) from January 1, 2003 through December 31, 2013, for janitorial service workers employed in the National Occupational Research Agenda (NORA) Services Sector. We constructed multivariable models to identify factors associated with higher medical costs and increased time lost from work.ResultsThere were 2,390 janitorial service compensable claims available for analysis. There were significant differences in injury type and other factors by gender, age, and language preference. Linguistic minority status was associated with longer time loss and higher median medical costs. Women were estimated to account for 35% of janitorial service workers but made up 55% of the compensable claims in this study.ConclusionsJanitorial service workers comprise a large vulnerable occupational group in the U.S. workforce. Identifying differences by injury type and potential inequitable outcomes by gender and language is important to ensuring equal treatment in the workers' compensation process.Practical applicationsThere were significant differences in injury and individual characteristics between men and women in this study. Women had twice the estimated rate of injury to men, and were more likely to require Spanish language materials. Improving communication for training and knowledge about the workers' compensation system appear to be high priorities in this population of injured janitorial service workers.     

Assessment of perceived injury risks and priorities among truck drivers and trucking companies in Washington State

Problem

The trucking industry experiences one of the highest work-related injury rates. Little work has been conducted previously in the United States to assess the hazards, needs, and injury prevention priorities in trucking. Method: Two separate industry-wide surveys of 359 trucking companies and 397 commercial truck drivers were conducted in Washington State. Results: Trucking companies and drivers both ranked musculoskeletal and slip, trip, fall injuries as the top two priorities. Controlling heavy lifting, using appropriate equipment, and addressing slippery surfaces were frequently listed as solutions. There appears to be a gap in safety climate perception between workers and employers. However, driver and company priorities agreed with industry workers' compensation claims. There is room for safety program management improvement in the industry. The study findings detail opportunities for prioritizing and reducing injuries. Impact on Industry: This information can be used to focus and design interventions for the prevention of work-related injuries while improving industry competitiveness.     

A 6-year survey of road traffic accidents in Southwest China: Emphasis on traumatic brain injury

Background: The objective of this study is to provide an up-to-date overview of the patterns of injuries, especially traumatic brain injury (TBI) caused by RTAs and to discuss some of the public health consequences. Methods: A scientific team was established to collect road traffic accidents occurring between 2013 and 2018 in Chongqing, Southwest China. For each accident, the environment-, vehicle-, and person- variables were analyzed and determined. The overall injury distribution and TBI patterns of four types of road users (driver, passenger, motorcyclist and pedestrian) were compared. The environmental and time distribution of accidents with TBI were shown by bar and pie chart. The risks of severe brain injury whether motorcyclist wearing helmets or not were compared and the risk factors of severe TBI in pedestrian were determined by odds ratio analysis. Results: This study enrolled 2131 accidents with 2741 persons of all kind of traffic participants, 1149 of them suffered AIS1+ head injury and 1598(58%) died in 7 days. The most common cause of deaths is due to head injury with 714(85%) and 1266(79%) persons died within 2 hours. Among 423 persons suffered both skull fracture and intracranial injury, 102 (24.1%) have an intracranial injury but no skull fractures, while none of the skull fractures without intracranial injury was found. Besides, motorcyclists without a helmet were at higher risks for all the brain injury categories. The risk of pedestrian suffering severe TBI at an impact speed of more than 70 km/h is 100 times higher than that with an impact speed of less than 40 km/h. Conclusion: It is urgently needed to develop a more reliable brain injury evaluation criterion for better protection of the road users. We believe that strengthening the emergency care to head injury at the scene is the most effective way to reduce traffic fatality.     

Coding agricultural injury: Factors affecting coder agreement

Objectives: To determine coders’ agreement level for the Occupational Injury and Illness Classification System (OIICS) source of injury and injury event codes, and the Farm and Agricultural Injury Classification (FAIC) code in the AgInjuryNews.org and to determine the effects of supplemental information and follow-up discussion in final code assignments. Methods: Two independent researchers initially coded 1304 injury cases from AgInjurynews.org using the OIICS and the FAIC coding schemes. Code agreement levels for injury source, event, and FAIC and the effect of supplemental information and follow-up discussions on final coding was assessed. Results: Coders’ agreement levels were almost perfect for OIICS source and event categories at the 3-digit level, with lower agreement at the 4-digit level. By using supplemental information and follow-up discussion, coders improved the coding accuracy by an average 20% for FAIC. Supplemental information and follow-up discussions had helped finalize the disagreed codes 55% of the time for OIICS source coding assignments and 40% of time for OIICS event coding assignments for most detailed 4-digit levels. Five key themes emerged regarding accurate and consistent coding of the agricultural injuries: inclusion/exclusion based on industry classification system; inconsistent/discrepant reports; incomplete/nonspecific reports; effects of supplemental information on coding; and differing interpretations of code selection rules. Practical applications: Quantifying the level of agreement for agricultural injuries will lead to a better understanding of coding discrepancies and may uncover areas for improvement to coding scheme itself. High level of initial and final agreement with FAIC and OIICS codes suggest that these coding schemes are user-friendly and amenable to widespread use.     

Fewer workers' compensation claims and lower claim costs if employers with high injury rates achieved the rates of their safer peers

Introduction: Employers engaged in similar business activities demonstrate a range of workers' compensation claim rates. Workplace injuries and illnesses could be prevented if employers with high claim rates achieved the claim rates of their safer peers. Methods: We used Washington workers' compensation claims data for years 2013–2015 to calculate rates of compensable claims (eligible for disability or time loss benefits, if unable to work four days after injury) and total accepted claims (compensable plus medical-aid only claims) for each employer. We estimated the number and cost of claims to occur if employers with high claim rates reduced them to the rates of employers at the 25th percentile, adjusted for insurance risk class, employer size, and injury type. To evaluate the impact of setting more or less ambitious goals, we also estimated reductions based on claim rates at the 10th and 50th percentiles. Results: Over 43% of claims and claim costs would be prevented if employers with higher claim rates lowered them to the 25th percentile using either total accepted or compensable claim rates as the benchmark outcome. The estimated claim cost savings from benchmarking to compensable claims was nearly as great as the estimate based on benchmarking to total accepted claims ($308.5 mil annually based on compensable claims vs. $332.4 mil based on total accepted claims). Restaurants and Taverns had the greatest number of potentially prevented compensable claims. Colleges and Universities and Wood Frame and Building Construction had the greatest potential reduction in compensable claim costs among larger and smaller employers, respectively. Conclusion: Substantial reductions in workers' compensation claims and costs are possible if employers achieve the injury rates experienced by their safer peers. Practical application: Evaluating the range of workplace injury rates among employers within industry groups identifies opportunities for injury prevention and offers another approach to resource allocation.     

Perceived safety climate, job demands, and coworker support among union and nonunion injured construction workers

PROBLEM: This study evaluated injured construction workers' perceptions of workplace safety climate, psychological job demands, decision latitude, and coworker support, and the relationship of these variables to the injury severity sustained by the workers. METHODS: Injury severity was assessed using the Health Assessment Questionnaire (HAQ), which evaluates functional limitations. Worker perceptions of workplace variables were determined by two instruments: (a) the Safety Climate Measure for Construction Sites and (b) the Job Content Questionnaire (JCQ). RESULTS: The overall model explained 23% of the variance in injury severity, with unique contributions provided by union status, the Safety Climate Score, and Psychological Job Demands. A positive significant correlation was found between injury severity and the Safety Climate Scores (r = .183, P = .003), and between the Safety Climate Scores and union status (r = .225, P < .001). DISCUSSION: There were statistically significant differences between union and nonunion workers' responses regarding perceived safety climate on 5 of the 10 safety climate items. Union workers were more likely than nonunion workers to: (a) perceive their supervisors as caring about their safety; (b) be made aware of dangerous work practices; (c) have received safety instructions when hired; (d) have regular job safety meetings; and (e) perceive that taking risks was not a part of their job. However, with regard to the 49-item JCQ, which includes Coworker Support, the responses between union and nonunion workers were very similar, indicating an overall high degree of job satisfaction. However, workers who experienced their workplace as more safe also perceived the level of management (r = -.55, P < .001) and coworker (r = -.31, P < .001) support as being higher. IMPACT ON INDUSTRY: The findings of this study underscore the critical need for construction managers to alert workers to dangerous work practices and conditions more frequently, and express concern and praise workers for safe work in a manner that is culturally acceptable in this industry. Workplace interventions that decrease the incidence and severity of injuries, but that are flexible enough to meet a variety of potentially competing imperatives, such as production deadlines and client demands, need to be identified.     

Fall-related traumatic brain injury in children ages 0–4 years

Introduction: Falls are the leading cause of traumatic brain injury (TBI) for children in the 0–4 year age group. There is limited literature pertaining to fall-related TBIs in children age 4 and under and the circumstances surrounding these TBIs. This study provides a national estimate and describes actions and products associated with fall-related TBI in this age group. Method: Data analyzed were from the 2001–2013 National Electronic Injury Surveillance System–All Injury Program (NEISS–AIP), a nationally representative sample of emergency departments (ED). Case narratives were coded for actions associated with the fall, and product codes were abstracted to determine fall location and product type. All estimates were weighted. Results: An estimated 139,001 children younger than 5 years were treated annually in EDs for nonfatal, unintentional fall-related TBI injuries (total = 1,807,019 during 2001–2013). Overall, child actions (e.g., running) accounted for the greatest proportion of injuries and actions by others (e.g., carrying) was highest for children younger than 1 year. The majority of falls occurred in the home, and involved surfaces, fixtures, furniture, and baby products. Conclusions: Fall-related TBI in young children represents a significant public health burden. The majority of children seen for TBI assessment in EDs were released to home. Prevention efforts that target parent supervision practices and the home environment are indicated. Practical applications: Professionals in contact with parents of young children can remind them to establish a safe home and be attentive to the environment when carrying young children to prevent falls.     

Occupational injury rates among Norwegian farmers: A sociotechnical perspective

Introduction: This study addressed relative injury risk among Norwegian farmers, who are mostly self-employed and run small farm enterprises. The aim was to explore the relative importance of individual, enterprise, and work environment risks for occupational injury and to discuss the latent conditions for injuries using sociotechnical system theory. Method: Injury report and risk factors were collected through a survey among Norwegian farm owners in November 2012. The response rate was 40% (n = 2,967). Annual work hours were used to calculate injury rates within groups. Poisson regression using the log of hours worked as the offset variable allowed for the modeling of adjusted rate ratios for variables predictive of injury risk. Finally, safety climate measures were introduced to assess potential moderating effects on risk. Results: Results showed that the most important risk factors for injuries were the design of the workplace, type of production, and off-farm work hours. The main results remained unchanged when adding safety climate measures, but the measures moderated the injury risk for categories of predominant production and increased the risk for farmers working with family members and/or employees. An overall finding is how the risk factors were interrelated. Conclusions: The study identified large structural diversities within and between groups of farmers. The study drew attention to operating conditions rather than individual characteristics. The farmer’s role (managerial responsibility) versus regulation and safety climate is important for discussions of injury risk. Practical Applications: We need to study sub-groups to understand how regulation and structural changes affect work conditions and management within different work systems, conditioned by production. It is important to encourage actors in the political-economic system to become involved in issues that were found to affect the safety of farmers.     

The crash severity impacts of fixed roadside objects

INTRODUCTION: This study analyzes the in-service performance of roadside hardware on the entire urban State Route system in Washington State by developing multivariate statistical models of injury severity in fixed-object crashes using discrete outcome theory. The objective is to provide deeper insight into significant factors that affect crash severities involving fixed roadside objects, through improved statistical efficiency along with disaggregate and multivariate analysis. METHOD: The developed models are multivariate nested logit models of injury severity and they are estimated with statistical efficiency using the method of full information maximum likelihood. RESULTS: The results show that leading ends of guardrails and bridge rails, along with large wooden poles (e.g. trees and utility poles) increase the probability of fatal injury. The face of guardrails is associated with a reduction in the probability of evident injury, and concrete barriers are shown to be associated with a higher probability of lower severities. Other variables included driver characteristics, which showed expected results, validating the model. For example, driving over the speed limit and driving under the influence of alcohol increase the probability of fatal accidents. Drivers that do not use seatbelts are associated with an increase in the probability of more severe injuries, even when an airbag is activated. IMPACT ON INDUSTRY: The presented models show the contribution of guardrail leading ends toward fatal injuries. It is therefore important to use well-designed leading ends and to upgrade badly performing leading ends on guardrails and bridges. The models also indicate the importance of protecting vehicles from crashes with rigid poles and tree stumps, as these are linked with greater severities and fatalities.     

The direct cost burden of 13 years 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.     

我国工伤保险费率机制的探讨

工伤保险费率机制是工伤保险制度的核心问题 ,对工伤保险基金的稳定性、工伤预防效能的发挥和企业参与的积极性等多方面产生直接影响。笔者在调查和研究我国工伤保险现状的基础上 ,结合欧美等国的成功经验 ,分析了我国工伤保险费率机制存在的问题 ,并在差别费率划分、档次、费率调整、风险共担模式、收支平衡和促进工伤预防等方面提出了独自见解和相应的建议。