title: Surveillance for work-related skull fractures in Michigan.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  A more comprehensive system to identify and target interventions for workplace injuries was implemented using hospital and emergency department medical records.
authors.affiliation: Michigan State University, Department of Medicine, Division of Occupational and Environmental Medicine, 909 Fee Rd, Rm 118, East Lansing, MI 48824, USA. Electronic address: Joanna.Kica@hc.msu.edu.
authors.forename: Joanna
authors.initials: J
authors.lastname: Kica
authors.affiliation: Michigan State University, Department of Medicine, Division of Occupational and Environmental Medicine, East Lansing, MI, USA. Electronic address: rosenman@msu.edu.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Rosenman
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D016272:Occupational Health; D062486:Public Health Surveillance / Q000379:methods*; D017751:Safety Management / Q000458:organization & administration; D012887:Skull Fractures / Q000453:epidemiology*; D014942:Workers' Compensation / Q000706:statistics & numerical data*; D017132:Workplace / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Enforcement inspections; Injury prevention; Occupational injuries; Public health surveillance; Traumatic brain injury (TBI)