Work-Related Amputations in North Carolina: The Need for More Data

BACKGROUND: Work-related amputations (WRA) are one of the most debilitating injuries that can occur in the workplace. These injuries can result in permanent disability and force workers to adjust their lives physically and psychologically at work and at home. The objective of this study was to use emergency department data to calculate and describe WRA in North Carolina.

METHODS:   Emergency department (ED) data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NCDETECT) was used to identify patients who were aged 16 years or older, and assigned a primary or contributing International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) amputation diagnosis code of 885.0-.1, 886.0-.1, 887.0-.7, 895.0-.1, 896.0-.3 and/or 897.0-.7 following ED discharge. Only work-related ED visits were considered, which were identified by using workers’ compensation as the primary source of payment.

RESULTS:   A total of 1,253 amputation-related ED visits were identified during 2010; 264 (21%) of these were insured by workers’ compensation. 273 assigned ICD-9-CM codes and 475 mechanism of injury (e-codes) were reviewed among the 264 work-related cases. The highest rates of WRA occurred among employed persons 45 to 54 years of age (8.1 ED visits per 100,000 employed persons), and were five times greater for males (10.6 per 100,000 employed residents) when compared to females (1.9 per 100,000). Among assigned ICD-9-CM codes, complete/partial amputation of fingers other than the thumb was the most commonly reported WRA (205 assigned codes, 75%), followed by complete/partial amputation of the thumb (53, 19%). Among assigned e-codes, the most commonly reported mechanisms of injury categories were: accidents caused by machinery (111, 23%); non-electronic or non-gas-powered hand tools, instruments, implements or objects used for cutting and/or piercing (38, 8%); appendages being caught accidentally in or between objects (35, 7%); and electronic or gas-powered hand tools and household appliances or implements (23, 5%).

CONCLUSIONS:   Our analysis of ED data identified approximately 32% more WRA cases than the US Department of Labor’s Survey of Occupational Injury and Injury (SOII). However, important variables that can further help describe patterns of WRA, such as race/ethnicity, type of industry and occupation were not available in ED data. More detailed case-based surveillance data that includes these variables, as well as employer information, would be useful to inform decisions regarding more targeted safety compliance enforcement, educational, and consultation outreach activities.