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Emergency Medicine Australasia (2014) 26, 188–193

doi: 10.1111/1742-6723.12166

TRAUMA

Occupational fall injuries presenting to the emergency department Hyung Min SON,1 Sun Hyu KIM,1 Sang Do SHIN,2 Hyun Wook RYOO,3 Hyun Ho RYU4 and Ji Ho LEE5 1 Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea, 2Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea, 3Department of Emergency Medicine, Kyoungpook National University Hospital, Daegu, Korea, 4Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea, and 5 Department of Occupational and Environmental Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea

Abstract Objectives: This study was performed to evaluate occupational and fall injuries presenting to the ED, the risk factors associated with falls among all occupational injuries, and factors affecting prognosis. Methods: Data from ED-based Occupational Injury Surveillance System were analysed to investigate the occupational injuries. The 2147 occupational injury subjects were divided into two groups: fall (n = 213, 9.9%) and non-fall (n = 1934, 90.1%). Data including baseline and clinical characteristics were compared between the groups. Results: The mean age was older in the fall group (46 vs 42 years old). The rate of construction site-related injury was 32% in the fall group and only 8% in the non-fall group. Injury occurrence during regular working hours (09.00 hours to 18.00 hours) was 70% in the fall group and 57% in the nonfall group. Injury severity using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS) was more severe in the fall group than in the nonfall group, and days away from work were longer in the fall group than the non-fall group. Older age, compared

with an age 60. Area of injury occurrence was divided into construction area or others, and time of injury occurrence was classified into regular working hours (09.00 hours to 18.00 hours) and other times. Cause of injury was divided into self-mistake or other causes, including machinery defect and poor working environment. Clinical characteristics comprising initial BP at ED, mental status, days of working loss after injury, results after ED and admission treatment, operation, and duration of admission were also investigated. Operation was defined as emergency operation or elective operation performed in the operating room, not primary closure because of simple lacerated wound in ED. Injury severity was measured using Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS) based on the ICD-10 code for injuries.17 Like the Abbreviated Injury Scale, every injury registered into the ICD-10 code was classified into five severity grades (1– 5) using calculated excess mortality ratio for all ICD-10 codes from the Korean National Injury Database. EMR-ISS, similar to the New Injury Severity Score, was measured as the sum of squares of three maximum severity grades. EMR-ISS severity was classified into four groups: mild (1 ≤ EMR-

ISS ≤ 8), moderate (9 ≤ EMR-ISS ≤ 24), severe (25 ≤ EMR-ISS ≤ 74) and critical (EMR-ISS ≤ 75 or death). Days away from work was determined as the time of the completion of treatment or, if this time was inaccurate, transfer to another hospital in the middle of treatment; predicted days away from work was also defined as days away from work. Return to work in terms of predicted days away from work was defined as return to the same workplace or to a similar job with full-time work. Predicted days away from work was determined as unit of week according to the diagnosis except 1 day in case of no need of further treatment after ED treatment; 1 or 2 weeks in case of discharge after ED treatment with need of further treatment; 1 to more weeks based on treatment process in case of hospitalisation. Comparison of general and clinical characteristics was performed between the fall and the non-fall groups using t-test and χ 2 -test. Univariate logistic regression analysis was used to analyse the factors affecting occupational fall injury, and multivariate logistic regression with stepwise method was performed using the significant variables from univariate logistic regression. Odds ratios were used to compare the risk of fatal falls for different population groups. A logistic regression analysis assessed critical predictors on the causes from falls and resulting from other causes (nonfalls). Confidence intervals (95%) of the odds ratios and P-values were calculated through these analyses. Linear regression analysis was used to analyse the factors associated with the days away from work that reflect the injury severity. Because the days away from work showed a right-skewed distribution, regression analysis was performed after log transformation. All statistical analyses were performed using spss for Windows 17.0 (SPSS, Chicago, IL, USA).

Results Patients with occupational injury (n = 2147) comprised a fall group of 213 (9.9%) and a non-fall group of 1934 (90.1%). Average age was 46 years in the fall group and 42 years in the non-fall group (P < 0.001). Men

predominated, with 90% in the fall group and 86% in the non-fall group (P = 0.158). Most of the patients had an educational level lower than high school (84% in the fall group and 76% in the non-fall group). More patients in the fall group transferred to study hospitals via another hospital after occupational injury than in the non-fall group. Contusion or laceration was the main injury mechanism in the non-fall group. Construction sites as the area of injury occurrence comprised 32% of the fall group and only 8% of the non-fall group. Injuries occurring during regular working hours comprised 70% and 57% of those in the fall group and non-fall group, respectively. Weekly working hours did not differ between the two groups, and there was no difference in self-mistake versus other causes of injury between the two groups (Table 1). BP at the time of ED presentation was not different between the two groups, but the GCS was lower in the fall group of patients than the non-fall group of patients. Injury severity using the EMR-ISS was more severe in the fall group than the nonfall group, and work absence was more prolonged in the fall group than in the non-fall group. Admission rate after ED treatment was 52% in the fall group and 19% in the non-fall group. The number of fatalities (proportion of total in the group) was nine (4.2%) in the fall group and 12 (0.6%) in the non-fall group. The operation rate was higher in the fall group (Table 2). As a result of univariate regression analysis to evaluate the factors affecting fall injury and multivariate regression analysis with valid variables from univariate regression, older age (as compared with those less than 29 years of age) and presence in a construction site during regular working hours were factors associated with fall injuries (Tables 3,4). Factors affecting the longer days away from work were older age, higher EMR-ISS, fall injury and poor workplace environmental conditions (Table 5).

Discussion Previous studies revealed evidence that occupational injuries are underestimated compared with their true

© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

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TABLE 1.

General characteristics of fall injuries among the occupation-related injuries

Age (years) Age group, number (%) (years) 15∼29 30∼44 45∼59 >60 Sex, male (%) Education (%) ≤High school ≥College ED presentation via other hospitals (%) Injury mechanism (%) Motor vehicle related Slip Contusion Penetration or laceration Machine related Fire or heat related Others Height of fall (m) Area of injury occurrence (%) Construction Others Time of injury occurrence (%) Regular working hours (09.00∼18.00 hours) Others Duration of work experience (months) Weekly working hours Self-estimation of cause of injury Self-mistakes Others (environment, fatigue etc.)

Fall (n = 213)

Non-fall (n = 1934)

P-value

46.4 ± 12.1

42.0 ± 13.1

Occupational fall injuries presenting to the emergency department.

This study was performed to evaluate occupational and fall injuries presenting to the ED, the risk factors associated with falls among all occupationa...
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