Refining the focus of construction injury surveillance

We conducted two studies of construction injury occurring at Denver International Airport (DL4), whose construction required 31 million work hours. Initially we conducted a retrospective cohort study that allowed estimation of injury and workers' compensation (WC) payment rates for strata such as size of employer and type of work; risk factors were also estimated. The second study examined written injury reports for 4,000 injuries at DIA. We modified Haddon's matrix to classify factors contributing to injury. We identified 108 factors within 4 broad categories: human, object, environment and organization. This approach provided information on rates at which each factor contributed to injury and the WC payment rates for each factor. A study shortcoming was that injury reports varied in completeness and quality. In a third ongoing study, to compensate for the shortcomings of injury reports, particularly to improve consistency and completeness of data, we designed a worker questionnaire completed immediately after injury, which included questions specific to hazards associated with each type of injury. Upon completion, the interviewer (a safety professional) uses the modified Haddon's matrix to note contributors to the injury and explain briefly the reasons for each notation. This requires the interviewer to consider a full set of possible factors and determine whether they contributed to injury. This process elicits richer data and places specific factors within the four higher-level categories. This process confer advantages on both contractors and researchers. Contractors can become immediately aware of contributing factors and ameliorate them quickly. The data can also be used in post hoc analysis of injury etiology. Moreover, the data are sufficiently flexible and complete that they can be coded into schemes describing sequences of events leading to injury, as well as those simply identifying factors contributing to injury. Haddon's matrix is invaluable in such analysis because it leads to a fuller understanding of the origins of the most proximate contributors to injury than would otherwise occur. Particularly for contractors and owners with significant safety infrastructures, this approach may be attractive, because it allows for more complete and quicker correction of specific hazards and, with systematic evaluation, recognition of more general safety concerns present on many construction sites.     

Closing the Aboriginal child injury gap: targets for injury prevention

Objective : To describe the leading mechanisms of hospitalised unintentional injury in Australian Aboriginal children and identify the injury mechanisms with the largest inequalities between Aboriginal and non‐Aboriginal children. Methods : We used linked hospital and mortality data to construct a whole of population birth cohort including 1,124,717 children (1,088,645 non‐Aboriginal and 35,749 Aboriginal) born in the state of New South Wales (NSW), Australia, between 1 July 2000 and 31 December 2012. Injury hospitalisation rates were calculated per person years at risk for injury mechanisms coded according to the ICD10‐AM classification. Results : The leading injury mechanisms in both groups of children were falls from playground equipment. For 66 of the 69 injury mechanisms studied, Aboriginal children had a higher rate of hospitalisation compared with non‐Aboriginal children. The largest relative inequalities were observed for injuries due to exposure to fire and flame, and the largest absolute inequalities for injuries due to falls from playground equipment. Conclusion : Aboriginal children in NSW experience a significant higher burden of unintentional injury compared with their non‐Aboriginal counterparts. Implications for Public Health : We suggest the implementation of targeted injury prevention measures aimed at injury mechanism and age groups identified in this study.     

Classification and coding of commercial fishing injuries by work processes: an experience in the Danish fresh market fishing industry

BACKGROUND: Work-related injuries in commercial fishing are of concern internationally. To better identify the causes of injury, this study coded occupational injuries by working processes in commercial fishing for fresh market fish. METHODS: A classification system of the work processes was developed by participation in fishing vessel trips where observations and video recordings of the work operations on board were collected. Subsequently the system was pilot tested using the Danish Maritime Authority injury reports. RESULTS: The developed classification system contains 17 main categories and up to 13 sub-categories of the work processes for each of the five different types of fishing. A total of 620 injury reports were reviewed and coded. Five percent (n = 33) of these were fatal injuries. The working processes were identified and coded according to the developed classification system for 553 (89%) injury reports: Danish seiner (n = 83), gill-netter (n = 122), beam trawler (n = 71), twin-trawler 2-T (n = 96), single/pair trawler 1-T (n = 181). Sixty-seven (11%) of the reports were unclassifiable due to lack of information. Preparing, shooting, and hauling of the gear and nets accounted for 50% of the injuries; they were most serious type of injuries such as fractures and sprains. Walking about the ship, in particular embarking and disembarking, climbing and descending ladders accounted for nearly one-fifth of the injuries. CONCLUSION: We found that the working processes related to working with the gear and nets vary greatly in the different fishing methods. Coding of the injuries to the specific working processes allows for targeted prevention efforts.     

Risk factors for injury among construction workers at Denver International Airport

Background The Denver International Airport construction project provided a rare opportunity to identify risk factors for injury on a large construction project for which 769 contractors were hired to complete 2,843 construction contracts. Workers' compensation claims and payroll data for individual contracts were recorded in an administrative database developed by the project's Owner-Controlled Insurance Program. Methods From claims and payroll data linked with employee demographic information, we calculated injury rates per 200,000 person-hours by contract and over contract characteristics of interest. We used Poisson regression models to examine contract-specific risk factors in relation to total injuries, lost-work-time (LWT), and non-LWT injuries. We included contract-specific expected loss rates (ELRs) in the model to control for prevailing risk of work and used logistic regression methods to determine the association between LWT and non-LWT injuries on contracts. Results Injury rates were highest during the first year of construction, at the beginning of contracts, and among older workers. Risk for total and non-LWT injuries was elevated for building construction contracts, contracts for special trades companies (SIC 17), contracts with payrolls over $1 million, and those with overtime payrolls greater than 20%. Risk for LWT injuries only was increased for site development contracts and contracts starting in the first year of construction. Contracts experiencing one or more minor injuries were four times as likely to have at least one major injury (OR &equals: 4.0, 95% CI (2.9, 5.5)). Conclusions Enhancement of DIA's safety infrastructure during the second year of construction appears to have been effective in reducing serious (LWT) injuries. The absence of correlation between injury rates among contracts belonging to the same company suggests that targeting of safety resources at the level of the contract may be an effective approach to injury prevention. Interventions focused on high-risk contracts, including those with considerable overtime work, contracts held by special trades contractors (SIC 17), and contracts belonging to small and mid-sized companies, and on high-risk workers, such as those new to a construction site or new to a contract may reduce injury burden on large construction sites. The joint occurrence of minor and major injuries on a contract level suggests that surveillance of minor injuries may be useful in identifying opportunities for prevention of major injuries. Am. J. Ind. Med. 34:113–120, 1998. © 1998 Wiley-Liss, Inc.     

Improving the sensitivity and specificity of the abbreviated injury scale coding system

The Abbreviated Injury Scale with Epidemiologic Modifications (AIS 85-EM) was developed to make it possible to code information about anatomic injury types and locations that, although generally available from medical records, is not codable under the standard Abbreviated Injury Scale, published by the American Association for Automotive Medicine in 1985 (AIS 85). In a population-based sample of 3,223 motor vehicle trauma cases, 68 percent of the patients had one or more injuries that were coded to the AIS 85 body region nonspecific category external. When the same patients' injuries were coded using the AIS 85-EM coding procedure, only 15 percent of the patients had injuries that could not be coded to a specific body region. With AIS 85-EM, the proportion of codable head injury cases increased from 16 percent to 37 percent, thereby improving the potential for identifying cases with head and threshold brain injury. The data suggest that body region coding of all injuries is necessary to draw valid and reliable conclusions about changes in injury patterns and their sequelae. The increased specificity of body region coding improves assessments of the efficacy of injury intervention strategies and countermeasure programs using epidemiologic methodology.     

Fatal work related injuries in agricultural production and services to agriculture sectors of New Zealand, 1985-94

OBJECTIVES—To describe work related fatal injuries to agricultural workers in New Zealand to identify priority areas for further research and injury control measures.
METHODS—Injury deaths in New Zealanders aged 15-84 inclusive for the period 1985-94 were identified and the coroner's files for these obtained. These files were then reviewed to determine whether the death arose as a result of work activities. Those deaths considered to be work related were coded for information relating to decedent demographics and the circumstances of the fatal injury. Work related deaths from injury occurring in the agricultural production and services to agriculture sectors were analysed.
RESULTS—The rate of fatal injuries to male agricultural workers over the study period was 21.2/100 000, with injury deaths in the agricultural sectors accounting for nearly a quarter of all work related fatal injuries in New Zealand in that time. There was no significant decline in fatal injuries to agricultural workers in the study decade. Workers in the 65-84 age bracket were at substantially higher risk of fatal injury than other age groups. Machinery and motor vehicles were commonly associated with fatal injury, with overturns on or next to embankments and slopes being the most frequent scenario.
CONCLUSIONS—The results of this study highlight fatal injuries in older workers and machinery incidents (particularly tractors overturning) as priority areas for further research into contributing factors and injury control measures.


Keywords: agriculture; fatal injury     

Reliability of report coding of hospital referrals in primary care versus practice-based coding

Coding of medical data according to a suitable classification is useful to epidemiological research in primary care but its implementation at practice-based level may be considered as extra work by participating practitioners. Secondary coding from reported data can be considered as a possible alternative to practice-based coding. The purpose of this study was to assess the inter-rater reliability of report coding versus practice-based coding of morbidity data. Via teleinformatics, 300 French general practitioners from the French Sentinel epidemiological network transmitted in free text, on a continuous real-time basis, the health problems generating each hospital referral they made since August 1997. All these reports were centrally coded according to the International Classification of Primary Care (ICPC). A subsample of 120 reports were coded in local practices for comparison. Codes resulting from blind centralized free-text coding were compared with practice-based codes. For the 120 referrals reported, the measure of agreement for the number of codes was 0.65 (95% confidence interval [CI], CI: 0.52–0.77), and for the chapters selected, 0.84 (95% CI: 0.78–0.91). Discrepancies attributable to the centralized coding only occurred for 7.5% of the referrals, and were due to the lack of specificity of the information transmitted as free text. A thesaurus of correspondences between problem(s) generating referrals and ICPC codes was built from 5000 referrals, and has been used routinely for the automated report coding of an additional sample of 1691 referrals. We conclude that centralized coding is a reliable alternative to practice-based coding in primary care, provided that physicians give sufficiently specific information.     

35 498例伤害住院患者伤害发生类型和外部原因帕累托图分析

目的分析某院伤害住院患者伤害发生类型和伤害发生的外部原因按ICD-10分类汇总情况,为合理配置医疗资源,加强该地区的伤害性疾病防治工作提供可靠依据。方法运用帕累托图法,对该院10年间35498例伤害住院患者伤害发生类型和伤害发生的外部原因进行分析。结果10年间该院伤害住院患者人数逐年上升。利用帕累托图分析发现伤害住院患者伤害发生类型主要有头部损伤,下肢损伤,肩及上肢损伤,各类中毒;伤害发生的外部原因主要有交通事故,跌倒,砸伤、玻璃和刀刺割伤、机器事故。结论采用帕累托图对伤害住院患者伤害发生类型和伤害发生的外部原因构成情况进行分析,找出了该地区伤害患者疾病谱,为医院和相关部门进一步完善该地区急救体系,优化资源配置,进一步做好伤害预防和控制工作提供数据支持。     

Use of employer administrative databases to identify systematic causes of injury in aluminum manufacturing

BACKGROUND: Employer administrative files are an underutilized source of data in epidemiologic studies of occupational injuries. METHODS: Personnel files, occupational health surveillance data, industrial hygiene data, and a real-time incident and injury management system from a large multi-site aluminum manufacturer were linked deterministically. An ecological-level measure of physical job demand was also linked. This method successfully created a database containing over 100 variables for 9,101 hourly employees from eight geographically dispersed U.S. plants. RESULTS: Between 2002 and 2004, there were 3,563 traumatic injuries to 2,495 employees. The most common injuries were sprain/strains (32%), contusions (24%), and lacerations (14%). A multivariable logistic regression model revealed that physical job demand was the strongest predictor of injury risk, in a dose dependent fashion. Other strong predictors of injury included female gender, young age, short company tenure and short time on current job. CONCLUSIONS: Employer administrative files are a useful source of data, as they permit the exploration of risk factors and potential confounders that are not included in many population-based surveys. The ability to link employer administrative files with injury surveillance data is a valuable analysis strategy for comprehensively studying workplace injuries, identifying salient risk factors, and targeting workforce populations disproportionately affected.     

Fatal injuries to teenage construction workers in the US

BACKGROUND: The construction industry is second only to agriculture in the annual number of fatal injuries in workers less than 18 years of age. We examined fatal injury reports for youth and adult workers to determine risk factors for injury and applicability of existing child labor regulations. METHODS: The US Occupational Safety & Health Administration (OSHA) investigation data for fatal work injuries from 1984 through 1998 were reviewed with respect to type of event, employer characteristics, and apparent violations of existing child labor laws under the Fair Labor Standards Act (FLSA). We also examined whether the employer met exemption criteria for federal enforcement of child labor or OSHA regulations. RESULTS: The fatality rate for teenage construction workers age 19 and younger was 12.1 per 100,000 per year, slightly less than for adult workers. Teenage workers who were fatally injured were more likely than adults to have been employed at non-union construction firms (odds ratio (OR) = 4.96, P < 0.05), firms with fewer than 11 employees (OR = 1.72, P < 0.05), and their employers were more likely to have been cited by OSHA for safety violations (OR = 1.66, P < 0.05) than for firms which were investigated because of a fatality in an adult worker. Fatalities in teenagers were more likely to occur in special construction trades such as roofing. Among fatalities in workers less than 18 years of age, approximately one-half (49%) of the 76 fatal injuries were in apparent violation of existing child labor regulations. We estimated that in 41 of the 76 cases (54%) the employer's gross annual income exceeded the $500,000 threshold for federal enforcement of child labor laws. Only 28 of 76 cases (37%) were at construction firms with 11 or more employees, which are subject to routine OSHA inspections. CONCLUSIONS: Fatal injuries in teenage construction workers differed from those in adults in that they were more likely to be at small, non-union firms of which a substantial proportion were exempt from federal enforcement of child labor laws and from routine OSHA inspections. Safety programs for young construction workers should include small, non-union construction firms and those in special construction trades such as roofing. We did not identify specific areas for new regulation but the number of fatalities reviewed was small.     

School Injury Among Ottawa-Area Children: A Population-Based Study

BACKGROUND:  Injuries are the leading cause of death among Canadian children and are responsible for a substantial proportion of hospitalizations and emergency department visits. This investigation sought to identify the factors associated with the likelihood of sustaining an injury at school among Ottawa-area children.
METHODS:  Children presenting to Ottawa-area hospitals and urgent care clinics from January to December 2002 (n = 24,074) were included for analysis. The frequency of school injuries by sex, age group, type of injury, and hospitalization was analyzed. Multivariate logistic regression was used to assess the factors associated with sustaining an injury at school. The school activities most associated with injury and the most frequent types of school injuries were assessed.
RESULTS:  A total of 4287 Ottawa-area children were injured at school in 2002, representing 18% of all injuries. Children aged 5-9 years and 10-14 years were more likely to have school injuries than older children (aged 15-19 years) (OR = 3.07, 95% CI = 2.77-3.40 and OR = 3.10, 95% CI = 2.83-3.37, respectively). The most frequently encountered school injuries were fractures (n = 1132) and musculoskeletal injury (n = 907). The most frequent mechanisms of school injuries were "playing" (n = 1004) and "informal sports" (n = 1503).
CONCLUSIONS:  Many children get hurt at school, particularly during informal recreation activities. Environmental modification and increased supervision are strategies that may reduce school injuries.     

公共卫生信息分类与编码研究

目的建立公共卫生数据集分类框架与编码体系,实现对公共卫生数据集信息的统一描述、标识、查询和管理。方法以公共卫生领域各项业务、科研和管理活动中产生的能够通过信息系统进行处理的基本数据集为分类对象,采用线分类与面分类法相结合的方法,按小类、子类、主类、主题域4个层级构建分类框架,并依次对具有共同主题特征的公共卫生数据集进行逐级抽象与归并,生成各层级类目,再应用组配技术对数据集进行系统编码。结果（1）建立了包括疾病预防控制、公共卫生服务、公共卫生管理和卫生监督4个主题域,18个主类,49个子类,205个小类的公共卫生信息分类框架;（2）设计了由7位主分类代码和包括地区代码、组织机构代码、疾病分类代码和学科分类代码4段30位复分类代码组成的编码体系。应用公共卫生9个业务领域提供的50个基本数据集进行分类归入效能检验和编码检索测试,均达到预期目标。结论认为这种分类与编码方法适用于公共卫生领域信息资源交换的分类与编码实践。     

The WHO safe community program for injury prevention: evaluation of the impact on injury severity

Despite the fact that injuries consume a considerable amount of health care resources world-wide, 3.5 million people die from unintentional injuries each year. To handle this central public health problem, WHO has introduced the Safe Community accreditation for injury prevention programs. This study was to investigate the impact from a Safe Community program with regard to injury severity. Data were collected in Motala municipality (population = 41 000), Östergötland county, Sweden, during one year before and one year after program intervention, from two sources: registration of trivial (AIS 1) and non-trivial (AIS 2–6) unintentional injuries from all acute care episodes in the area and recollection of hospital bed days from discharge registers. The incidence of non-trivial injuries treated in health care was found to have decreased by 41% (95% confidence interval, 37–45%), while the trivial injuries increased by 16% (9–22%). The larger decrease of non-trivial injuries was observed in all ages and injury event environments. The total number of bed days at emergency hospitals due to injuries decreased by 39% (37–41%) from 1983–84 to 1989, while the hospital bed utilization for other reasons decreased by 9% (8–9%). The study showed that implementation of a WHO Safe Community program led to the harm from unintentional injuries within the community being considerably more reduced than that of the injury incidence. In future assessments of injury prevention programs, classification of injury severity should be included to increase the validity of inter-program comparisons.     

15家部队医院军人眼外伤流行病学特征分析

目的 分析部队医院军人眼外伤住院患者的流行病学特征.方法 收集15家部队三级甲等医院2001-2005年军人眼外伤住院病例,对其人几学特征、致伤原因等流行病学概况进行回顾性分析.结果 军人眼外伤患者716人,治疗772只外伤眼.占同期住院外伤眼的7.46%.男女性别比46.73:1,平均年龄(24.99±8.40)岁.以17～29岁多发(82.27%),7.82%为双眼伤.近视眼矫正术后外伤并发症占一定比例,机械性眼外伤占92.49%,非机械性眼外伤占7.51%.主要致伤原因有运动(17.62%)、爆炸(11.92%)、斗殴(11.40%)等,51.55%发生于工作和训练时间,30.31%发生于军事洲练场地.预后出院统计,眼球开放伤等导致22只眼被摘除,9只眼无光感,62.16%视力恢复至0.5以上.结论 军人是眼外伤不可忽视的特殊人群,年轻男军人是部队眼外伤防治的重点人群,军事体育训练、演习和国防施工建设等是军人职业性眼损伤的主要原因.