Surveillance for work-related skull fractures in Michigan

• Multisource surveillance for work-related skull fractures was instituted.
• Workplace inspections where the skull fracture occurred identified safety hazards.
• 86% more work-related skull fractures were identified than in the BLS estimate.
• The inclusion of facial bone fractures affected the outcomes of the study.

Objectives: The objective was to develop a multisource surveillance system for work-related skull fractures. Methods: Records on work-related skull fractures were obtained from Michigan's 134 hospitals, Michigan's Workers' Compensation Agency and death certificates. Cases from the three sources were matched to eliminate duplicates from more than one source. Workplaces where the most severe injuries occurred were referred to OSHA for an enforcement inspection. Results: There were 318 work related skull fractures, not including facial fractures, between 2010 and 2012. In 2012, after the inclusion of facial fractures, 316 fractures were identified of which 218 (69%) were facial fractures. The Bureau of Labor Statistic's (BLS) 2012 estimate of skull fractures in Michigan, which includes facial fractures, was 170, which was 53.8% of those identified from our review of medical records. The inclusion of facial fractures in the surveillance system increased the percentage of women identified from 15.4% to 31.2%, decreased severity (hospitalization went from 48.7% to 10.6% and loss of consciousness went from 56.5% to 17.8%), decreased falls from 48.2% to 27.6%, and increased assaults from 5.0% to 20.2%, shifted the most common industry from construction (13.3%) to health care and social assistance (15.0%) and the highest incidence rate from males 65 + (6.8 per 100,000) to young men, 20–24 years (9.6 per 100,000). Workplace inspections resulted in 45 violations and $62,750 in penalties. Conclusions: The Michigan multisource surveillance system of workplace injuries had two major advantages over the existing national system: (a) workplace investigations were initiated hazards identified and safety changes implemented at the facilities where the injuries occurred; and (b) a more accurate count was derived, with 86% more work-related skull fractures identified than BLS's employer based estimate. Practical Applications: A more comprehensive system to identify and target interventions for workplace injuries was implemented using hospital and emergency department medical records.