Presentation on theme: "Work related traumatic brain injury due to assault"— Presentation transcript:
1 Work related traumatic brain injury due to assault Tatyana Mollayeva, MD, PhD (cand)
2 Co-authors and funding Shirin Mollayeva, BSc (cand), John Lewko, PhD, Angela Colantonio, PhDFunding:
3 DisclosureThe authors have no conflict of interest to disclose
4 Traumatic brain injury: definition “an alteration in brain function, or other evidence of brain pathology, caused by an external force”11Brain Injury Association of America. About Brain Injury Retrieved June 10, 2012, from
5 Background ≈628,000 Canadians live w/ brain injury-related disability1 Over 50% are under 20 years of age1Most 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 workplace2,3wrTBIs, : 3.6% assault-related, likely underestimate4Occupational Health and Safety Act wrt workplace violence5 - assault at work a broad public health concernPhysical and psychological effects severe, assoc. with great financial loss6NHCC and BIAC Election messaging. (2011, 3 29). Retrieved 04 04, 2014, from Brain injury Association of Canada:Workplace Safety and Insurance Board’s (WSIB) 2005 Annual Report. Retrieved 01 01,2014, fromColantonio 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.Kim H, Colantonio A, Chipman M. Traumatic brain injury occuring at work. Neurorehabil, 2006; 21:Canadian Centre for Occupational Health and Safety Act. Retrieved 4 11, 2013, from
6 Gap in knowledge and study objectives Despite evidence for risks of work-related assault, data on wrTBI due to assault in Canada is lackingObjectives:Assess extent of assault resulting in TBI by sex, across occupational sectors in OntarioExamine related demographic and workplace characteristicsProvide better understanding of circumstances of incidents
7 Data collectionCase series design, examined all claims with 2004 injury date and categorized as “intracranial injury” or “concussion”, also examined “traumatic” fatalities1,006 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”1Qualitative and qualitative data analyses1. 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.
8 VariablesSocio-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
9 Data analysisFrequency distributions, central dispersion for demographic and injury variablesDenominator: Statistics Canada 2004 data on employment, by sex1Case categorization:2Type 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)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):Bowie V. Workplace Violence. New South Wales: Work Cover; 2002.
11 Demographic characteristics Age range=20-64 (median 37 y.o.)≈assault-related wrTBI claim rate=9.85/1 million Ontario employeesClaim rate for women≈11.79/1 mil Ontario workers; men≈8.4/1 milFrequency of wrTBI caused by physical assault greater in female employees (59.1%), higher than that for all TBI cases of all mechanisms (42.3%)
13 Sex differences within sectors Health care/social services sector:Rate of wrTBI six-fold higher for female workersEducation sector:Rate of wrTBI four-fold higher for female workersPolice/guard/law enforcement sector:Rate of wrTBI 13-fold higher for male workers
15 Temporal characteristics Highest number of TBIs due to assault in 2004 occurred in March and NovemberWeekly peaks – Mondays and FridaysMost injuries occurred in late morning and early afternoon
16 Event-related characteristics Images: Yow Canada Inc.
17 Event-related characteristics >40% of assaults resulting in wrTBI occurred in one-on-one interactions with clients; >1/3 - dealing with irate/angry clients23% - attempts to restrain/follow suspicious individuals12% - dealing with disabled/special needs individuals or those with awareness issues7% - 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%)
18 Cost of claims Total days of disability=8,953 10 female and 5 male workersTotal days of disability=8,953Women accrued more disability days compared to men (5,166 vs. 3,787)75% off work for >2 months
19 LimitationsEstimates yielded conservative as approximately 70% of Ontario workers are insured by WSIBRemaining 30% may not have similar characteristicswrTBI 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
20 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 aggressionOne-on-one with client: self-defense, working in pairsGuarding property, following suspect: restraint and self- defense trainingMobile workplace: training to recognize potentially threatening situations, client awareness of zero tolerance policy for aggression and assault toward workers
21 ConclusionsFirst paper examining wrTBI due to assault; representative sample of workers; focus on sexwrTBI due to assault across industries and types of physical aggressionResults can serve as a basis for further wrTBI surveillance work; stimulate development of appropriate control efforts in work-related assault