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