Elsevier

Safety Science

Volume 38, Issue 3, August 2001, Pages 241-256
Safety Science

Epidemiology of occupational acute traumatic hand injuries: a literature review

https://doi.org/10.1016/S0925-7535(01)00004-2Get rights and content

Abstract

The purpose of this review was to summarize the literature on occupational, acute, traumatic hand injury and suggest directions for future research. In 1996, the leading occupational injury treated in United States' hospital emergency departments was an acute hand injury (e.g. laceration, crush or fracture). These injuries affected 30% of an estimated 3.3 million injured workers (990,000). Cuts and lacerations of the fingers ranked third after back and leg strains in the number of lost workday cases in the USA in 1994. The incidence rate of hand injuries studied in seven manufacturing environments around the world ranged from 4 to 11 per 100 workers per year. Workers aged 24 years or less had the highest risk of hand injury. Men had higher rates of severe hand injury than women.

Despite the high frequency and significant amount of lost work time associated with these injuries, they are poorly understood from an etiological perspective. There is only one case-control study of occupational hand injury in the literature. That study suggested an important role for both fixed (age) and transient risk factors (doing an unusual task) at the time of the injury. More analytic epidemiological research is needed to identify potentially modifiable risk or protective factors (e.g. glove use) for acute hand injuries. In this regard, the case-crossover design, a relatively new epidemiological approach using cases as their own controls, could prove an efficient method for determining transient, modifiable risk factors for acute, occupational hand injury.

Introduction

Acute traumatic occupational hand injury resulting from sudden or instantaneous events is common yet poorly understood from an etiological perspective. The National Electronic Injury Surveillance System reported that fingers and hands were the most frequent anatomic sites injured at work (e.g. a laceration or fracture) and treated in hospital emergency departments in the USA. In 1996, these injuries occurred to approximately 1 million workers. (Morbidity, Mortality, Weekly Report, 1998). A recent published analysis of the number of reported US Bureau of Labor Statistics (BLS) lost-workday cases indicated cuts and lacerations to the fingers ranked third after back and leg strain cases nationwide in 1994. (Courtney and Webster, 1999). Despite the obvious frequency of these injuries, there has been only one published case-control study of acute traumatic injury to the hand in the work environment (Hertz and Emmett, 1986), leaving large gaps in our understanding of potential risk factors for hand injuries. This review examines the epidemiology of acute, occupational, sudden-onset injury to the fingers and hand. Directions for future research in this area are also suggested. For purposes of the review, fingers, thumb and hand are considered as one anatomic unit unless otherwise specified.

Section snippets

Methods

Large injury and illness registries such as the BLS annual Survey of Occupational Injury and Illness (SOII) and the National Electronic Injury Surveillance System (NEISS) were used to estimate the frequency and incidence of hand injuries. Published research reports dating back to 1970 were identified through computerized databases such as PubMed, Grateful Med, NIOSHTIC using the keywords: “occupational”, “injury”, “hand”, and “upper extremity”. The upper extremity was defined as the upper and

Descriptive epidemiology

Based on data from a random sample of US hospital emergency departments from the NEISS, fingers and hands were the most common anatomic sites injured at work and treated in emergency departments in 1996. Hospital coders determined work-relatedness of these injuries by review of emergency department charts and admission information. These injuries occurred to 30% of an estimated 3.3 million injured workers (990,000) (Morbibity Mortality Weekly Report, 1998). Another clinical-setting-based study

Analytic epidemiology

The only published case-control study of risk factors for hand injury in the literature was published by Hertz and Emmett (1986). This study included 124 municipal government employees who sustained a hand injury at work. Each case employee was individually matched to a control employee who was at work during the time of the case's injury. Cases and controls were also matched on gender and job. All interviews were completed within 8 days of the index date of the injury via a telephone

Directions for future epidemiological research

Descriptive studies have suggested that in addition to workplace and worker characteristics, transient work practices (e.g. uncommon work tasks, work methods, or tools), unusual conditions of work equipment (e.g. malfunctioning tools or equipment), and individual and work organization-related factors (e.g. fatigue, rushing, distractions) may be potential risk factors (Nag and Patel, 1998, Bureau of Labor Statistics 1982, Kelsh and Sahl, 1998). Boyle (Morbidity Mortality Weekly Report, 1982, 1983

Acknowledgements

We are grateful to our colleagues Larry Layne, Barbara Webster, Edward Clancy and David Parker for their helpful comments on earlier versions of the manuscript. Patricia Boelsen carefully prepared the manuscript for submission. This work was supported in part by NIOSH grant R01 OH-03763-01.

References (56)

  • D.A Redelmeier et al.

    Interpretation and bias in case-crossover studies

    Clin. Epidemiol.

    (1997)
  • J Saari

    Characteristics of tasks associated with the occurrence of accidents

    J. Occ. Acc.

    (1977)
  • O Skov

    The incidence of hospital-treated occupational hand injuries

    J. Hand Surgery

    (1994)
  • O Skov et al.

    Time off work after occupational hand injuries

    J Hand Surg

    (1999)
  • G Askins et al.

    High-energy roller injuries to the upper extremity

    The Journal of Trauma

    (1986)
  • J.D Bennett et al.

    Epidemiology of hand and finger injuries of coal miners in the United States. Proc. Symp. Soc. Mine Engineers

    United States Department of Labor, Mine Safety & Health Administration, Denver, CO

    (1986)
  • D Boyle et al.

    Nature, incidence and cause of work-related amputations in Minnesota

    Am J Ind Med.

    (2000)
  • D Boyle et al.

    Medical, personal and occupational outcomes for work-related amputations in Minnesota

    Am. J. Ind. Med.

    (2000)
  • Bureau of Labor Statistics, 1982. United States Department of Labor: work-related hand injuries and upper extremity...
  • A Carlsson

    Hand injuries in Sweden in 1980

    J. Oc. Acc.

    (1984)
  • Y Cheng

    Explaining disablement in modern timeshand injured workers' accounts of their injuries in Hong Kong

    Soc. Sci. Med.

    (1997)
  • T.K Courtney et al.

    Disabling occupational morbidity in the United Statesan alternative way of seeing the Bureau of Labor Statistics data

    J. Occ. Env. Med.

    (1999)
  • C.G Drury et al.

    Human factors in consumer product accident investigation

    Human Factors

    (1983)
  • L Ferguson et al.

    Nurse practitioner sutured wounds — a quality assurance review

    AAOHN J.

    (1992)
  • B Grunert et al.

    Psychological adjustment following work-related hand injury: 18-month follow-up

    Annals of Plastic Surgery

    (1992)
  • M Hagberg et al.

    Conceptual and definitional issues in occupational injury epidemiology

    Am. J. Ind. Med.

    (1997)
  • K Hanecke et al.

    Accident risk as a function of hour at work and time of day as determined from accident data and exposure models for the German working population

    Scand. J. Work Environ. Health

    (1998)
  • A Hanrahan et al.

    A critical review of the literature on sharps injuriesepidemiology, management of exposures and prevention

    J. Adv. Nursing

    (1997)
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