Work-related injuries in a state trauma registry: Relationship between industry and drug screening Terry L. Bunn, PhD, Svetla Slavova, PhD, and Andrew C. Bernard, MD, Lexington, Kentucky BACKGROUND: Work-related injuries exert a great financial and economic burden on the US population. The study objectives were to identify the industries and occupations associated with worker injuries and to determine the predictors for injured worker drug screening in trauma centers. METHODS: Work-related injury cases were selected using three criteria (expected payer source of workers’ compensation, industry-related e-codes, and work-related indicator) from the Kentucky Trauma Registry data set for years 2008 to 2012. Descriptive analyses and multiple logistic regression were performed on the work-related injury cases. RESULTS: The ‘‘other services’’ and construction industry sectors accounted for the highest number of work-related cases. Drugs were detected in 55% of all drug-screened work-related trauma cases. Higher percentages of injured workers tested positive for drugs in the natural resources and mining, transportation and public utilities, and construction industries. In comparison, higher percentages of injured workers in the other services as well as transportation and public utilities industries were drug screened. Treatment at Level I trauma centers and Glasgow Coma Scale (GCS) scores indicating a coma or severe brain injury were both significant independent predictors for being screened for drugs; industry was not a significant predictor for being drug screened. The injured worker was more likely to be drug screened if the worker had a greater than mild injury, regardless of whether the worker was an interfacility transfer. CONCLUSION: These findings indicate that there may be elevated drug use or abuse in natural resources and mining, transportation and public utilities, as well as construction industry workers; improved identification of the specific drug types in positive drug screen results of injured workers is needed to better target prevention efforts. (J Trauma Acute Care Surg. 2014;77: 280Y285. Copyright * 2014 by Lippincott Williams & Wilkins) LEVEL OF EVIDENCE: Epidemiologic study, level III. KEY WORDS: Work-related injury; drugs; industry. W ork-related injuries exert a great financial and economic burden on the US population. In 2010, the total costs of work injuries were estimated to be $176.9 billion, including wage and productivity losses, medical costs, and administra- tive costs. 1 According to the National Academy of Social In- surance, workers’ compensation programs alone paid $57.5 billion in benefits and $28.1 billion in medical benefits asso- ciated with work-related injuries in the United States in the year 2010. 2 State trauma registry data have the potential to identify worker injuries by industry and occupation since it contains an indicator to ascertain work relatedness and have information on the industry and occupation categories of the injured worker. 3 The combination of the work-related indicator, workers’ compensation as the expected payer, and work-related e-codes is associated with high specificity in the surveillance of work-related injuries. 4 Data from state trauma registries are also useful for the identification of the presence of drugs and/or alcohol associated with injuries. Approximately 9.3% of adolescent blunt trauma patients admitted to two local Level I trauma centers had positive toxicology results for drugs and alcohol. 5 In another study, trauma patients in an academic Level I trauma center with positive drug and/or alcohol screen results and penetrating trauma were more likely to have arrived dead to the hospital compared with those with negative drug and alcohol screen results. 6 The prevalence of illicit drug use in the workforce has been estimated to be 14.1%, while the estimated prevalence of illicit drug use in the workplace has been estimated at 3.1%. 7 The objectives of the present study were to identify the in- dustries and occupations associated with worker injuries treated in trauma centers and to determine the predictors for injured worker drug screening in trauma centers. PATIENTS AND METHODS Trauma Registry Data Data for the present study were obtained from the Kentucky Trauma Registry database for years 2008 to 2012 and represent the most severe traumatic injuries treated at Kentucky trauma centers and reported to the Kentucky Trauma Registry. Trauma registry data were collected according to recommended ele- ments in National Trauma Data Standards (NTDS). 8 Data element names, definitions, types, schemes analyzed in this ORIGINAL ARTICLE J Trauma Acute Care Surg Volume 77, Number 2 280 Submitted: January 2, 2014, Revised: March 14, 2014, Accepted: March 14, 2014. From the Kentucky Injury Prevention and Research Center (T.L.B., S.S.), College of Public Health, and Department of Surgery (A.C.B.), College of Medicine, University of Kentucky, Lexington, Kentucky. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH. NIOSH had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. Address for reprints: Terry L. Bunn, PhD, Kentucky Injury Prevention and Research Center, 333 Waller Ave, Suite 242, Lexington, KY 40504; email: tlbunn2@uky.edu. DOI: 10.1097/TA.0000000000000303 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.