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
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.
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
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
Work-Related SF Reporting Sources
 Hospitals/Emergency Departments (ED)
 Workers’ Compensation Agency (WC)
 Michigan Fatality Assessment and Control
Evaluation (MIFACE)
Work-Related SF Reporting Sources cont.
 Hospitals/Emergency Departments (ED)
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


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.
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



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
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)
Work-Related SF Reporting Sources cont.
 Michigan Fatality Assessment and Control
Evaluation (MIFACE)
 Skull fracture as a primary or secondary cause of death.
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.
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).
2010 Michigan Reports – By Source
HOSPITALS/EDs (91)
100
46
3
BLS
41
1
3
MIFACE (8)
1
19
WCA (62)
Number of Individuals: 114
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)
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”
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”
Worker Demographics, Michigan 2010
Race*
 Males: 95 (83.3%)
 Average Age: 43
Age range: 17-75
5.2% 3.4%
1.7%
5.2%
Caucasian
AfricanAmerican
Asian
Hispanic
Other
84.5%
*Race available only for 50.9% of all individuals.
Cause of Injury, Michigan 2010
 Cause of injury specified: 95 (83.3%) individuals
Fall
45.3%
Struck By
34.7%
Medical Condition
7.4%
Assault
6.3%
MVA
5.3%
Machine
1.1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Loss of Consciousness, Michigan 2010
 Loss of consciousness specified: 85 (74.6%)
individuals
45.9%
54.1%
YES
NO
Part of Skull Injured by ICD-9 code,
Michigan 2010
Part of Skull Injured, Michigan 2010
 Part of skull specified: 114 (100%) individuals
62.3%
Base (ICD-9: 801)
Other and Unqualified (ICD-9: 803)
18.4%
10.5%
Vault (ICD-9: 800)
4.4%
Face Unspecified
2.6%
Jaw/Chin/Cheek
Face Multiple
0.9%
Multiple (ICD-9: 804)
0.9%
0%
10%
20%
30%
40%
50%
60%
70%
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.
Type of Injury, Michigan 2010
 Type of fracture specified: 25 (21.9%) individuals
Depressed Fracture
64.0%
Displaced Fracture
24.0%
Linear Fracture
8.0%
Compound Fracture
4.0%
0%
10%
20%
30%
40%
50%
60%
70%
Industry of Skull Fracture, Michigan 2010
 Sufficient
information
for industry
classification:
105 (92.1%)
individuals
Industry Classification (NAICS)
Number
Construction (23)
14
Primary Metal Manufacturing (33)
11
Public Administration (92)
9
Transportation and Warehousing (48)
8
Health Care and Social Assistance (62)
8
Educational Services (61)
7
Agriculture, Forestry, Fishing and Hunting (11)
6
Retail Trade (44)
6
Accomodation and Food Services (72)
6
Admin. and Support and Waste Mgt and Remediation Svcs (56)
6
Wood Product Manufacturing (32)
5
Wholesale Trade (42)
4
Finance and Insurance (52)
3
Utilities (22)
3
Real Estate and Rental and Leasing (53)
2
Professional, Scientific and Technical Services (54)
2
Food Manufacturing (31)
2
Sporting Goods, Hobby, Book and Music Stores (45)
1
General Warehousing and Storage (49)
1
Information (51)
1
Total
105
Percent
13.3
10.5%
8.6%
7.6%
7.6%
6.7%
5.7%
5.7%
5.7%
5.7%
4.8%
3.8%
2.9%
2.9%
1.9%
1.9%
1.9%
1.0%
1.0%
1.0%
100.0%
Top 5 Industries by Cause of Injury,
Michigan 2010
INDUSTRY (ICD-9 code)
Construction (23)
Primary Metal Manufacturing (33)
Public Administration (92)
Transportation and Warehousing (48)
Health Care and Social Assistance (62)
Struck By Fall Assault MVA Med. Cond. Unknown TOTAL
2
5
4
4
1
9
3
0
1
3
0
0
1
1
0
1
0
0
1
0
0
2
1
0
0
2
1
3
1
4
14
11
9
8
8
Seasonality of Injury, Michigan 2010
 Season of injury specified: 114 (100%)
individuals
30.7%
21.9%
Summer
Spring
Fall
Winter
23.7%
23.7%
WC as Source of Payment, Michigan
2010
WC DATABASE
YES
NO TOTAL
Yes, as Skull Fracture
Yes, as Other Description
No
22
27
22
2
11
30
24
38
52
Skull Fracture Injury Narrative Examples,
Michigan 2010
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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.
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.
MIOSHA Enforcement Inspections
 MIOSHA referral criteria:
 2010 Hospitalization
 Within past 6 months
 All NAICS codes
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.
Comparison of Different Data Surveillance
Systems
 BLS – 100 (includes nasal fractures)
 WC – 43 (includes nasal fractures)
 MI multisource – 114 (excludes nasal fractures)
114
120
100
100
80
60
43
40
20
0
WC
BLS
MI multisource
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
THANK YOU
Questions?
kica@msu.edu
www.oem.msu.edu