1. Multi-Source Surveillance System for Work-Related Skull Fractures in Michigan Joanna Kica, MPA Kenneth D. Rosenman, MD Department of Medicine Occupational and Environmental Medicine Michigan State University

2. 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.

3. 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

4. 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

5. Work-Related SF Reporting Sources  Hospitals/Emergency Departments (ED)  Workers’ Compensation Agency (WC)  Michigan Fatality Assessment and Control Evaluation (MIFACE)

6. 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 of face 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)

7. 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)

8. Work-Related SF Reporting Sources cont.  Michigan Fatality Assessment and Control Evaluation (MIFACE)  Skull fracture as a primary or secondary cause of death.

9. 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.

10. 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).

11. 2010 Michigan Reports – By Source

12. 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)

13. 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”

14. 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”

15. Worker Demographics, Michigan 2010  Males: 95 (83.3%)  Average Age: 43 Age range: 17-75 *Race available only for 50.9% of all individuals.

16. Cause of Injury, Michigan 2010  Cause of injury specified: 95 (83.3%) individuals

17. Loss of Consciousness, Michigan 2010  Loss of consciousness specified: 85 (74.6%) individuals

18. Part of Skull Injured by ICD-9 code, Michigan 2010

19. Part of Skull Injured, Michigan 2010  Part of skull specified: 114 (100%) individuals

20. 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.

21. Type of Injury, Michigan 2010  Type of fracture specified: 25 (21.9%) individuals

22. Industry of Skull Fracture, Michigan 2010  Sufficient information for industry classification: 105 (92.1%) individuals

23. Top 5 Industries by Cause of Injury, Michigan 2010

24. Seasonality of Injury, Michigan 2010  Season of injury specified: 114 (100%) individuals

25. WC as Source of Payment, Michigan 2010

26. 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.

27. 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.

28. MIOSHA Enforcement Inspections  MIOSHA referral criteria:  2010 Hospitalization  Within past 6 months  All NAICS codes

29. 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.

30. Comparison of Different Data Surveillance Systems  BLS – 100 (includes nasal fractures)  WC – 43 (includes nasal fractures)  MI multisource – 114 (excludes nasal fractures)

31. 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

32. THANK YOU Questions? kica@msu.edu www.oem.msu.edu www.oem.msu.edu