Work related traumatic brain injury due to assault Tatyana Mollayeva, MD, PhD (cand)

Co-authors and funding 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 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/. 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 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: 269-278. 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) 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. Bowie V. Workplace Violence. New South Wales: Work Cover; 2002.

Results

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%)

Demographic characteristics

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 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

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 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

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!