Epidemiology of occupational acute traumatic hand injuries: a literature review
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.
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This research was completed during JP Cotnam's tenure as a Researcher at the Liberty Mutual Research Center. He is now with Atlantic Charter, Boston.