BACKGROUND: Based on the concept of the Sentinel Health Event, Ruttstein published a list in 1983 of 50 conditions [Sentinel Health Events (Occupational); SHE(O)] defined as: “unnecessary disease, disability, or untimely death which is occupationally related and whose occurrence may: 1) provide the impetus for epidemiologic or industrial hygiene studies; or 2) serve as a warning signal that materials substitution, engineering control, personal protection, or medical care may be required.” This list was updated in 1992 by Mullan to include 64 disease conditions (ICD-9), along with a designation (O) when further industry and occupation information is needed to establish the relationship of disease to occupation. A targeted provider reporting system (Sentinel Event Notification System for Occupational Risks – SENSOR) was developed by NIOSH and several states in 1987 to perform surveillance of selected occupational conditions (e.g., asthma, pesticide illness, traumatic fatalities, silicosis, sharps injuries). In the last decade, the universal adoption of electronic health records (EHR) offers tremendous opportunity for public health surveillance and tracking of specific work-related conditions using industry and occupation data. The objective of this analysis was to determine whether ICD-10 diagnosis codes can be used in sufficient detail and precision as the basis for an updated set of SHE(O)s for provider-based reporting to state and national public health agencies.
METHODS: The existing SHE(O) ICD-9 diagnosis codes of Ruttstein and Mullan were reviewed by two occupational medicine physicians and cross-walked to the appropriate ICD-10 codes. In addition, the entire ICD-10 code set was reviewed and additional SHE(O)s were added as potentially occupationally-related. Conditions were included for listing if they were by their inherent nature occupationally related, or for which an additional occupational history (industry, occupation, and exposure) would be needed to determine work-relatedness.
RESULTS: The updated ICD-10 list of SHE(O)s will be presented as a basis for improving surveillance of occupational disease in the United States.
CONCLUSIONS: After almost a quarter century, an updated set of ICD-10 codes using the concept of SHE(O) may still provide a useful rubric to improve ascertainment of occupational diseases in the U.S., with ongoing provider-based reporting to public health agencies using electronic health records.