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, PhD
Funding:

3. Disclosure
The 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”1
1Brain 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 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, : 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
NHCC 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, from
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.
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 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

7. 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.

8. 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

9. 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)
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.

10. Results

11. Demographic characteristics
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%)

12. Demographic characteristics

13. 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

14. Work experience
43% employed <1 year

15. 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

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 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%)

18. Cost of claims Total days of disability=8,953
10 female and 5 male workers
Total days of disability=8,953
Women accrued more disability days compared to men (5,166 vs. 3,787)
75% off work for >2 months

19. 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

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 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

21. 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

22. Thank you!