Mild Traumatic Brain Injury

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Mild Traumatic Brain Injury Powered By Docstoc
					Background:

• Traumatic brain injury (TBI) is a major public health                                                                                                                                                                                                                       MILD TRAUMATIC BRAIN INJURY
concern and a leading cause of disability worldwide(1).          AT THE WORKERS' COMPENSATION BOARD OF BRITISH COLUMBIA, CANADA, 1987 – 2001
    - In Canada, the incidence of people who acquire
    traumatic brain injury is estimated from 100/100,000
    to 200/100,000, annually(2).                                                                                                                                     CW Martin, K Noertjojo, CT Dunn
    - Based on these statistics, it is estimated that there                                                                                     The Evidence Based Practice Group, Clinical Services, Program Design Division
    are 6000 new traumatic brain injury cases in British
    Columbia annually.
                                                                                                                                                           The Workers’ Compensation Board of British Columbia
    - Twenty percent of these traumatic brain injury                                                                                                              Richmond, British Columbia, CANADA
    patients are predicted to die on the way to the
    hospital. Thus every year, there are 4800 survivors
    of traumatic brain injury in British Columbia (BC).
    - 3840 of these 4800 survivors are estimated to be                                                                                                                                                                                                                                                                • In the period 1987 - 2001, the occupational categories
                                                                                                                                                            No of new MTBI claims, 1987 - 2001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Total MTBI claim costs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Median amount of claim costs
                                                                                                                              800                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       18


                                                                                                                                                                                                                                                                         • During the 15 year
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      1500




    mild traumatic brain injury (MTBI) cases.                                                                                                                                                                                                                                                                         of MTBI claimants included:                                                                                                                                                                                                                                                                                                                                                       15



                                                                                                                                                                                                                                                                         period 1987 - 2001, on
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      1200
                                                                                                                              600



• MTBI is sometimes referred to by a number of other                                                                                                                                                                                                                                                                      - 10.2% in the primary resource sectors (agriculture,
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        12




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   $ Can (in million)
                                                                                                     No. of new cases
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       900


                                                                                                                                                                                                                                                                         average, there were 551




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          $ Can
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         9



names, such as concussion, minor brain injury, minor head                                                                                                                                                                                                                                                                 fishing, forestry, oil & gas)
                                                                                                                              400
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       600
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         6


                                                                                                                                                                                                                                                                         new claims filed as MTBI
injury and mild head injury(3).                                                                                               200
                                                                                                                                                                                                                                                                                                                          - 17.4% in the manufacturing sectors (food and                                                                                                                                                                                                               300                                                                                                               3



                                                                                                                                                                                                                                                                         (range 391 - 733).                                                                                                                                                                                                                                                                                                                                                                                                              0


    - Concussion is a general term that is usually                                                                                                                                                                                                                                                                        beverage, metal and non-metallic mineral products,
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         0
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              1987     1989     1991      1993          1995       1997   1999         2001                                  1987    1989   1991     1993          1995   1997    1999   2001
                                                                                                                                   0
                                                                                                                                            1987          1989          1991           1993           1995           1997            1999          2001
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Year                                                                                                       Year


    defined as a disturbance in neurological function                                                                                                                                         Year
                                                                                                                                                                                                                                                                                                                          wood and paper products, petroleum, coal, rubber,
    caused by the mechanical forces associated with                                                                                                              Incidence of MTBI, 1987 - 2001
                                                                                                                                                                                                                                                                                                                          plastic, chemicals and others)                                                                                                                                                                                                  • Even though there is a trend that the median claim
    rapid acceleration/deceleration of the head/brain.                                                                            .5

                                                                                                                                                                                                                                                                           • The average incidence                        - 11.8% in construction (general, heavy or road                                                                                                                                                                                 costs for each MTBI claim is rising over time, the
    - A mild concussion consists of 'seeing stars' or                                                                             .4

                                                                                                                                                                                                                                                                           rate of MTBI annually                          constructions and maintenance)                                                                                                                                                                                                  opposite tendency is observed for the annual total
                                                                                                     incidence (/100/year)




    feeling 'dazed', and does not necessarily involve                                                                             .3

                                                                                                                                                                                                                                                                           was about 0.3% (range                          - 12.4% in the transportation and warehousing                                                                                                                                                                                   MTBI claim costs.
    loss of consciousness. This is generally considered                                                                           .2

                                                                                                                                                                                                                                                                           0.20% - 0.43%)                                 industry                                                                                                                                                                                                                            - Median claim costs for females are about ½ - ⅔
    to be the lay definition of concussion                                                                                        .1
                                                                                                                                                                                                                                                                                                                          - 10.4% in the retail or wholesale trade business                                                                                                                                                                                  of their male counterparts
    - When loss of consciousness or neurological
                                                                                                                              0.0
                                                                                                                                           1987           1989          1991           1993           1995           1997            1999          2001
                                                                                                                                                                                                                                                                                                                          - 30.4% in service sectors (accommodation, food and                                                                                                                                                                                - The median cost of MTBI claim is highest among
    abnormalities occur within a short time after injury                                                                                                                                                                                                                                                                  leisure services, health care and social assistance,
                                                                                                                                                                                              Year

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             those older than 45 years
    and any subsequent 'confusion' or disorientation                                                                                          Comparison of mean total claim costs paid
                                                                                                                                                                                                                                                                                                                          education, business, utilities, professional, scientific
    resolves within hours, the condition is usually
                                                                                                                             35000
                                                                                                                                                                                                                                                                            • However, the average                        and technology services)                                                                                                                                                                                                                                           Comparion of number of claims and total costs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Even though there
    referred to as mild brain injury.
                                                                                                                             28000
                                                                                                                                                                                                                                                                            cost of claims for each                       - 7.3% in other sectors (public administration, federal                                                                                                                                                                                                      40
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        1987 - 2001
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    were only 44.1% of
• Two common criteria used to define the severity of brain                                                                   21000
                                                                                                                                                                                                                                                                            MTBI claim was at least                       government, and others)                                                                                                                                                                                                                                                                                                                                                                   MTBI claimants
                                                                                                  $ paid




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           % of total (1987 - 2001)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       30


injury include length of loss of consciousness and length of                                                                 14000
                                                                                                                                                                                                                                                                            double the average cost                   • The incidence of MTBI claims varied over time.                                                                                                                                                                                                                                                                                                                                              older than 35 years
                                                                                                                                                                                                                                                                            of all other claims in the                However, service sector and the manufacturing industry
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       20

post-traumatic amnesia(4).                                                                                                   7000
                                                                                                                                                                                                                                                          MTBI
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    in 1987 - 2001, the
    - Glasgow Coma Scale (GCS) is the most common
                                                                                                                                       0
                                                                                                                                              1987        1989         1991       1993         1995          1997          1999       2001
                                                                                                                                                                                                                                                          All claims
                                                                                                                                                                                                                                                                            same year                                 consistently showed the highest incidence compared to                                                                                                                                                                                                            10

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              No. of claims
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    total claim costs in
    instrument employed to assess level of                                                                                                                                                                                                                                                                            other job sectors
                                                                                                                                                                                         Year                                                                                                                                                                                                                                                                                                                                                                                           0                                                                                     Total costs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     <= 25             26-35                   36-45             >45
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    this age group -
    consciousness in the acute phase.                                                                                                      Comparison of median total claim costs paid
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Age (years)



                                                                                                                                                                                                                                                                            • The median cost was
                                                                                                               1200


    - Post-traumatic amnesia (PTA); is defined as the length                                                                                                                                                                                                                                                                                                                                                           MTBI claims by job sectors                                                                                                                    -represent 67.4% of the overall MTBI claim costs in
    of interval after trauma during which the patient is
                                                                                                                        900
                                                                                                                                                                                                                                                                            at least 3 times the                                                           40
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     the same period
    unable to store current events at the time of injury until                                                                                                                                                                                                              median cost of overall
                                                                                      $ paid




                                                                                                                        600




                                                                                                                                                                                                                                                                            claims during the same                                                                                                                                                                                                                                                        • Median claim costs were highest among claimants
    the return of continuous memory. Included in this time of                                                                                                                                                                                                                                                                                              30
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          in primary sector industries ($1,950 Can) and lowest
                                                                                                                        300




    PTA is the period of unconsciousness, confusion and                                                                                                                                                                                               MTBI
                                                                                                                                                                                                                                                                            year
                                                                                                                              0
                                                                                                                                           1987        1989          1991       1993      1995          1997          1999          2001
                                                                                                                                                                                                                                                      All claims
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          among those in the trade sectors ($475 Can).
    disorientation.                                                                                                                                                                    Year                                                                                                                                                                20
                                                                                                                                                                                                                                                                                                                                              %




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   prim ary res ources


• To date, there are no universally accepted criteria for the                                                                                                                                                                                                                                                                                                                                                                                                                                                                      m anufacturing
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Multivariate analysis:
diagnosis of MTBI. However, despite variations in criteria                                                                                         Total MTBI claim paid as % of total all claim paid                                                                                                                                                                                                                                                                                                                              cons tructions


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            - Only sex, duration of workloss days and days
between different organizations and experts, there are                                              2.5
                                                                                                                                                                               on the same year
                                                                                                                                                                                                                                                                           • Overall, MTBI claims                                                          10                                                                                                                                                                      trans port&warehouse




                                                                                                                                                                                                                                                                           represent approximately
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   trade
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            between injury and claim submission were
multiple points of agreement. Areas of agreement include a                                          2.0
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   s ervices

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            significant independent predictors the total claim
GCS score at admission of 13-15, brief loss of
                                                                                                    1.5
                                                                                                                                                                                                                                                                           1% - 2% of the overall                                                             0                                                                                                                                                                    others

                                                                                                                                                                                                                                                                                                                                                                                 1987                        1989                    1991                         1993                       1995             1997   1999   2001
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            costs
                                                                          %




consciousness, brief PTA (< 24 hours), and negative
                                                                                                    1.0
                                                                                                                                                                                                                                                                           claim costs during any
                                                                                                         .5
                                                                                                                                                                                                                                                                           given year
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Year                                                                          - Workloss days was the most important predictor
neuroimaging scans (usually CT scan) at presentation(4).                                            0.0                                                                                                                                                                                                                                                                                                                                                                                                                                                     of the total claims costs
                                                                                                                                                                                                                                                                                                                       • With regard to different job categories:
                                                                                                                                  1987             1989              1991         1993           1995               1997           1999            2001


                                                                                                                                                                                         Year
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Models on predicting days of workloss were not
• This exercise was conducted as a part of the Workers'                                                                                                                                                                                                                                                                   - The highest incidence was observed among                                                                                                                                                                                      presented here due to model's poor fit as measured
Compensation Board of British Columbia's (WCB of BC)              • In the 15 years period, the mean (± SD) duration                                                                                                                                                                                                      claimants aged 26 - 35 years old                                                                                                                                                                                                by its R2.
effort to further understand and improve on how workers           between injury and claim submission was 9.85 ± 22.3                                                                                                                                                                                                     -Majority of males were engaged in primary resource
with MTBI may best be assessed, diagnosed, treated,               days. The median was calculated to be 7 days.                                                                                                                                                                                                           businesses, construction and transportation sectors.                                                                                                                                                                            Independent variables                                                                                                                              B                SE* B                       p-value

compensated and ultimately reintegrated into the work                 - 52.6% of claimants submitted their claims by the                                                                                                                                                                                                  - Majority of females were engaged in the trades,                                                                                                                                                                               Constant (α)                                                                                                             - 899.9                                   1510.4                              0.55
force and community.                                                  first week post injury,                                                                                                                                                                                                                             services and others sectors                                                                                                                                                                                                     Females vs. males                                                                                                      - 8324.0                                    2861.1                          0.004
                                                                      - 33.7% by the second week and                                                                                                                                                                                                                  • Claim outcome is defined by the WCB of BC as to                                                                                                                                                                                   Number of workloss days                                                                                                               344.0                              5.1                       0.000
                                                                      - by the third week post head injury, 95.5% of MTBI                                                                                                                                                                                             whether the claimant was awarded health care only                                                                                                                                                                                   Days between injury and claim                                                                                            - 135.2                                         47.3                      0.004
 Material and Methods:                                                related claims had been submitted to the WCB of BC.                                                                                                                                                                                             (HCO), short term disability (STD), long term disability
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          submissions
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Model R2 = 0.46
                                                                      - There appears to be a significant trend across time                                                                                                                                                                                           (LTD) or if it was a fatal claim, survivor benefits.
 • Data was extracted from the WCB of BC data                         that this duration of claim submission is narrowing
                                                                                                                                                                                                                                                                                                                            - In the period 1987 - 2001, 0.5% of MTBI claims
 warehouse in January 2003.                                           such that claims are being submitted much sooner
                                                                                                                                                                                                                                                                                                                            were for health care only benefits, 96.2% were for
       - Crystal Report®™ ver 7.0 software was                        post injury than in past years
                                                                                                                                                                                                                                                                                                                            STD, 3.1% were for LTD and 0.1% were fatal                                                                                                                                                                                    Summary:
       employed to extract data from various database                                                                                                                                                                                                                                                                       -Majority of fatal claims occurred in the primary
                                                                                                                                                                        Duration between date of injury and claim submission
       formats into text files.                                                                                                        100
                                                                                                                                                                                                                                                                                                                            resources sectors.
       - The extraction was based on criteria using:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      • On average, the WCB of BC receives about 551
                                                                                                                                                                                                                                                                                                                            - Majority of the STD was awarded to claimants in                                                                                                                                                                             new MTBI related claims annually. Even though
          - ICD 9 code of 08500, 08501, 08502 and                                                                                          80
                                                                                                                                                                                                                                                                                                                            the service sectors.
          08509                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           MTBI claims comprise about 0.3% of the total annual
                                                                                                                                                                                                                                                                                                                            -The majority of LTD was awarded to claimants in                                                                                                                                                                              claims, the claim costs associated with MTBI is about
                                                                                                   % of cases




                                                                                                                                           60
          - and or (nature of injury 'concussion') and or                                                                                                                                                                                                                                                                   the construction, primary resources and service
          (body part 'brain').                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            1% - 2% of the total claim costs in that year.
                                                                                                                                           40
                                                                                                                                                                                                                                                                                                                            sectors                                                                                                                                                                                                                       • Half of the MTBI claimants submitted their claims
       - Nature of injury and source of injury coding are                                                                                                                                                                                                                                                                   -There was no relationship of duration between
       based on coding schemes developed by the                                                                                            20
                                                                                                                                                                                                                                                                                                           1 week
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          within a week post injury. The median duration
                                                                                                                                                                                                                                                                                                           2 weeks          injury and claim submission with the outcome of                                                                                                                                                                               between injury and claim submission was 7 days.
       Canadian Work Injuries Standard (CWIS) and                                                                                           0                                                                                                                                                              >2 weeks
                                                                                                                                                                                                                                                                                                                            the claim.
       the Canadian Standard Association (CSA).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           • Almost half of the MTBI claims were aged 21 - 35
                                                                                                                                                              1987




                                                                                                                                                                                  1989




                                                                                                                                                                                                         1991




                                                                                                                                                                                                                                   1993




                                                                                                                                                                                                                                                          1995




                                                                                                                                                                                                                                                                            1997




                                                                                                                                                                                                                                                                                      1999




                                                                                                                                                                                                                                                                                             2001

                                                                                                                                                                                                                                                                                                    All*




   • For the purpose of this report, analysis was limited                                                                                                                                                                                     Year                                                                              12
                                                                                                                                                                                                                                                                                                                                                          Median number of days on short term disability
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             • The overall median days                                    years. Males were 3-4 times more likely to file MTBI
   to data from the period 1987 - 2001 (15 years)                                                                                                                                                                                                                                                                               10
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             of MTBI claimants on STD                                     claims compared to females.
  • Data was then translated and analyzed further by                                                                                       Distribution of age and sex at time of injury
                                                                                                                                                                                                                                                                                                                                      8
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             in the period 1987 - 2001                                    • Half of all MTBI claimants were on STD for 7 days.
  employing SPSS for Windows ver. 12.0                                                                                                                                                                                                                                             • The average age of                                                                                                                                                                                                                                                   Only about 15% were on STD for > 10 weeks.
                                                                                                                                                                                                                                                                                                                      days




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             was 8 days with a mean (±
                                                                                                     60                                                                                                                                                                                                                               6




 • Appropriate parametric and non-parametric                                                                                                                                                                                                                                       claimants was                                      4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Females spent less days on STD as compared to
                                                                                                     45
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             SD) of 63.7 ± 204.9 days).
                                                                                                                                                                                                                                                                                   relatively stable at 30                                                                                                                                                                                                                                                males. Older claimants(> 45 years) recorded longer
                                                                            Age (years) +- 1 SD




                                                                                                                                                                                                                                                                                                                                      2



 statistical procedures were employed in the univariate                                                                                                                                                                                                                                                                               0                                                                                                                                                      This has not varied much in
 analyses subsequently undertaken
                                                                                                     30
                                                                                                                                                                                                                                                                                   years (range from 34 -                                          1987             1989              1991            1993            1995           1997             1999            2001

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          median STD times.
                                                                                                                                                                                                                                                                                                                                                                                                             Year
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             the last 15 years.
 • Multivariate analysis was conducted in order to
                                                                                                     15
                                                                                                                                                                                                                                                                 females
                                                                                                                                                                                                                                                                                   37 years old)                                                                                                                                                                                                                                                          • The median claim cost for MTBI has been rising
 explore the independent contribution of various                                                               0
                                                                                                                                       1987          1989            1991       1993          1995           1997           1999            2001
                                                                                                                                                                                                                                                                 males
                                                                                                                                                                                                                                                                                                                                              60
                                                                                                                                                                                                                                                                                                                                                                                             Distribution of days on STD
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 • About half of the                      across time, however, the annual total cost of MTBI
 factors, such as age, sex, claim year, in selected                                                                                                                             Year of injury                                                                                                                                                                                                                                                                                                                   MTBI claims were                         has been declining. Costs of MTBI claims among
 outcome criteria, including claim costs and workloss
                                                                                                                                                                                                                                                                                                                                              45
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 on STD for ≤ 1                           females was less than males. The highest median
 days                                                              • Almost half of the claimants were age 21 - 35 years                                                                                                                                                                                                                      30                                                                                                                                               Days on STD       week, 12.8% for 2                        cost of claims was observed among those aged 45
                                                                                                                                                                                                                                                                                                                       %




       - Multiple linear regression was employed for               old. Interestingly, there were a large number of                                                                                                                                                                                                                                                                                                                                                                                 <=1wk
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 weeks, 10.2%                             years or older.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2 wks



       these outcome analyses                                      claimants older than 50 years (data not shown).                                                                                                                                                                                                                            15
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    3-4 wks      between 3-4                              • About 0.1% of MTBI claims were fatal; more than
       - Dummy variables were created whenever                                                                                                                                                                                                                                                                                                 0
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    5-10 wks

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    >10wks       weeks, 12.8%                             95% were for STD only. 3.1% of MTBI claims are on
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 between 5-10                             LTD.
                                                                                                                                                                                                                                                                                                                                                           198 7



                                                                                                                                                                                                                                                                                                                                                                              198 9



                                                                                                                                                                                                                                                                                                                                                                                              199 1



                                                                                                                                                                                                                                                                                                                                                                                                              199 3



                                                                                                                                                                                                                                                                                                                                                                                                                             199 5



                                                                                                                                                                                                                                                                                                                                                                                                                                              199 7



                                                                                                                                                                                                                                                                                                                                                                                                                                                              199 9

                                                                                                                                                                                                                                                                                                                                                                                                                                                                      200 0

                                                                                                                                                                                                                                                                                                                                                                                                                                                                              200 1

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      All*




       appropriate                                                                                                                                            MTBI claims by sex
                                                                                          100

                                                                                                                                                                                                                                                                       • In general, males                                                                                                                             Year
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 weeks and 14.7%                          • Independent predictors for total claim costs
                                                                                                                                                                                                                                                                       were 3 - 4 times more
                                                                                                  80                                                                                                                                                                                                                                                All* is from 1987-2001



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 for > 10 weeks                           included: sex, duration of workloss days and days
                                                                                                                                                                                                                                                                       likely to have an MTBI
                                                                                                  60
                                                                   % of cases




 Results:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 between injury and claim submission
                                                                                                                                                                                                                                                                       claim compared to
                                                                                                  40



                                                                                                                                                                                                                                                                                                                                                                                 STD*: median days by age group
                                                                                                                                                                                                                                                                       females.                                                                                                                                                                                                               • There was somewhat a
                                                                                                  20
                                                                                                                                                                                                                                                                                                                                               15


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     References available upon request.
                                                                                                                                                                                                                                              males



 • In the period 1987 - 2001, 8260 claims were filed                                                0
                                                                                                                              1987              1989        1991        1993       1995         1997          1999          2001
                                                                                                                                                                                                                                              fem ales
                                                                                                                                                                                                                                                                                                                                               12

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              'dose-response
 under MTBI.
                                                                                                                                                                        Year of injury
                                                                                                                                                                                                                                                                                                                             number of days




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              relationship' between
                                                                                                                                                                                                                                                                                                                                                9




     - Of 8260, 27 (0.3%) workers were classified as                                                                                       - There was a significant increase in the number of
                                                                                                                                                                                                                                                                                                                                                6


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              age at injury and median
     having sustained a brief loss of consciousness.
                                                                                                                                                                                                                                                                                                                                                3


                                                                                                                                           female MTBI claimants across time                                                                                                                                                                    0                                                                                                                                             days on STD
     The majority (98.6%) had 'concussion' coded
                                                                                                                                                                                                                                                                                                                                                             <= 20            21-25          26-30       31-35          36-40         41-45           46-50           >50


                                                                                                                                           - Female MTBI claimants also tended to be older                                                                                                                                                                                                                   Age (years)


     (body part 'brain') as the nature of injury
                                                                                                                                                                                                                                                                                                                                                    * Short Term Disability



                                                                                                                                           than their male counterparts (data not shown)
     - Only 46 (0.6%) of claimants were registered as
     having multiple injuries.

				
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