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Case Identification of Work-Related Traumatic Brain Injury Using the Occupational Injury and Illness Classification System

Sears, Jeanne M. PhD, RN; Graves, Janessa M. PhD, MPH; Blanar, Laura MHS; Bowman, Stephen M. PhD, MHA

Journal of Occupational and Environmental Medicine: May 2013 - Volume 55 - Issue 5 - p 507–513
doi: 10.1097/JOM.0b013e31827ee018
Original Articles

Objectives: Traumatic brain injury (TBI) is one of the most common, costly, and disabling occupational injuries. Objectives included determining whether work-related TBI could be reliably identified using the Occupational Injury and Illness Classification System (OIICS) and describing challenges in developing an OIICS-based TBI case definition.

Methods: Washington State trauma registry reports and workers' compensation claims were linked (1998 to 2008). Trauma registry diagnoses were used as the gold standard for six OIICS-based TBI case definitions.

Results: The OIICS-based case definitions were highly specific but had low sensitivity, capturing less than a third of fatal and nonfatal TBI.

Conclusion: The use of OIICS versus International Classification of Diseases–Ninth Revision–Clinical Modification codes underestimated TBI and changed the attributable cause distribution, with potential implications for prevention efforts. Surveillance methods that can more fully and accurately capture the impact of work-related TBI across the United States are needed.

From the Department of Health Services (Dr Sears), School of Public Health, University of Washington, Seattle, Wash; Harborview Injury Prevention and Research Center (Dr Graves), Department of Pediatrics, School of Medicine, University of Washington, Seattle, Wash; Department of Health Services (Ms Blanar), School of Public Health, University of Washington, Seattle, Wash; Department of Community Health (Dr Bowman, primary appointment), School of Health and Human Services, National University, San Diego, Calif; and Center for Injury Research and Policy (Dr Bowman, adjunct appointment), Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.

Address correspondence to: Jeanne M. Sears, PhD, RN, Department of Health Services, School of Public Health, Box 354809, University of Washington, Seattle, WA 98195 (

This study was funded in part by the National Institute for Occupational Safety and Health (NIOSH, 1R03OH009883). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH. Dr Graves received fellowship support from the National Institute of Child Health and Human Development (T32HD057822).

The authors report no conflicts of interest.

©2013The American College of Occupational and Environmental Medicine