McPhail SM1,2, Jun D1,2, Peters S3
1Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia, 2Metro South Hospital and Health Service, Centre for Functioning and Health Research, Brisbane, Australia, 3Harvard University, T.H. Chan School of Public Health, Boston, United States
Background: Cycling and walking are two important forms of active transportation that are often used by people during work-related activities. Although walking and cycling are associated with health benefits, people undertaking these activities may also be vulnerable to traumatic injuries that require acute hospitalisation and lengthy rehabilitation that may be interrupted by readmissions to hospital.
Purpose: The purpose of the present study was to describe the number and characteristics of cases of acute work-related hospitalisations attributable to cycling or pedestrian related causes; as well as factors associated with hospitalisation outcomes, including re-presentations to hospital.
Methods: A total of 55105 work-related linked hospitalisation records for injuries and musculoskeletal conditions were identified from public and private hospitals in Queensland, Australia. ICD-10 primary diagnosis codes and external cause codes were used to identify acute injury-related hospitalisations attributed to pedestrian or cycling external cause codes. Multi-level models (cases clustered within hospitals) and survival analyses were used to examine patient and clinical factors associated with acute hospitalisation episode length of stay and re-hospitalisation (emergency department and inpatient admissions, not outpatient clinics).
Results: A total of 680 patients with work-related pedestrian or cycling injuries (76% male, mean (SD) age 39 (13) years) from 61 hospitals were identified from the health service records. Almost all patients returned directly home (676/680, >99%) at discharge from hospital; however, 162/680 (24%) were re-hospitalised within 6 months (median 49 days) under the same diagnosis category. The most common mechanisms of injury were pedestrian versus motor vehicle (234/680, 34%) and cyclist versus motor vehicle (224/680, 33%). Factors associated with longer length of stay in hospital included older age (p 0.01), pedestrian versus motor vehicle cause (p 0.001 versus cycling related mechanisms), diagnosis-based injury severity score (p 0.001) as well as specific injury types including fractures of the spine, lower limb, pelvis, or vessel injuries (all p 0.001 versus superficial / wound injuries), and cases with one or more transfers between hospitals within the same hospitalisation event. The primary predictor of re-presentations to hospital identifiable at the index admission was type of injury (spinal fractures, upper limb fractures, lower limb fractures, all p≤0.01 versus superficial injuries).
Conclusion(s): Active-transport related injuries were relatively infrequent among work-related hospitalisations but accounted for a range injuries likely to have had substantial personal and societal consequences. Motor vehicle collisions were a relatively common injury mechanism, but a substantial proportion of injury incidents did not involve motor vehicles. A strength of the study was the inclusion of all hospitals within the region. An important finding for the physiotherapy profession was the relatively high rates of re-hospitalisation in the sample. Further research to inform targeted strategies for reducing active transport-related injuries is warranted.
Implications: Active-transport injuries severe enough to require acute hospitalisation were relatively rare. However, clinicians working with these patients during early rehabilitation and return to work activities may need to take into account the relatively high hospital re-presentation rates, particularly among patients recovering from fractures. Further research is warranted to understand the extent to which hospital re-admissions can be prevented among this clinical sub-group.
Keywords: Occupation, Injury, Physical activity
Funding acknowledgements: SMM is supported by the (Australian) National Health and Medical Research Council / Medical Research Futures Fund
Purpose: The purpose of the present study was to describe the number and characteristics of cases of acute work-related hospitalisations attributable to cycling or pedestrian related causes; as well as factors associated with hospitalisation outcomes, including re-presentations to hospital.
Methods: A total of 55105 work-related linked hospitalisation records for injuries and musculoskeletal conditions were identified from public and private hospitals in Queensland, Australia. ICD-10 primary diagnosis codes and external cause codes were used to identify acute injury-related hospitalisations attributed to pedestrian or cycling external cause codes. Multi-level models (cases clustered within hospitals) and survival analyses were used to examine patient and clinical factors associated with acute hospitalisation episode length of stay and re-hospitalisation (emergency department and inpatient admissions, not outpatient clinics).
Results: A total of 680 patients with work-related pedestrian or cycling injuries (76% male, mean (SD) age 39 (13) years) from 61 hospitals were identified from the health service records. Almost all patients returned directly home (676/680, >99%) at discharge from hospital; however, 162/680 (24%) were re-hospitalised within 6 months (median 49 days) under the same diagnosis category. The most common mechanisms of injury were pedestrian versus motor vehicle (234/680, 34%) and cyclist versus motor vehicle (224/680, 33%). Factors associated with longer length of stay in hospital included older age (p 0.01), pedestrian versus motor vehicle cause (p 0.001 versus cycling related mechanisms), diagnosis-based injury severity score (p 0.001) as well as specific injury types including fractures of the spine, lower limb, pelvis, or vessel injuries (all p 0.001 versus superficial / wound injuries), and cases with one or more transfers between hospitals within the same hospitalisation event. The primary predictor of re-presentations to hospital identifiable at the index admission was type of injury (spinal fractures, upper limb fractures, lower limb fractures, all p≤0.01 versus superficial injuries).
Conclusion(s): Active-transport related injuries were relatively infrequent among work-related hospitalisations but accounted for a range injuries likely to have had substantial personal and societal consequences. Motor vehicle collisions were a relatively common injury mechanism, but a substantial proportion of injury incidents did not involve motor vehicles. A strength of the study was the inclusion of all hospitals within the region. An important finding for the physiotherapy profession was the relatively high rates of re-hospitalisation in the sample. Further research to inform targeted strategies for reducing active transport-related injuries is warranted.
Implications: Active-transport injuries severe enough to require acute hospitalisation were relatively rare. However, clinicians working with these patients during early rehabilitation and return to work activities may need to take into account the relatively high hospital re-presentation rates, particularly among patients recovering from fractures. Further research is warranted to understand the extent to which hospital re-admissions can be prevented among this clinical sub-group.
Keywords: Occupation, Injury, Physical activity
Funding acknowledgements: SMM is supported by the (Australian) National Health and Medical Research Council / Medical Research Futures Fund
Topic: Occupational health & ergonomics; Health promotion & wellbeing/healthy ageing; Orthopaedics
Ethics approval required: Yes
Institution: Metro South Health
Ethics committee: Metro South Health Human Research Ethics Committee
Ethics number: HREC/15/QPAH/317
All authors, affiliations and abstracts have been published as submitted.
