Post-traumatic peripheral vestibular disorders (excluding positional vertigo) in workers following head injury

Benign paroxysmal positional vertigo has typically been reported to be the most common cause of post-traumatic dizziness. There is however paucity in the literature about other peripheral vestibular disorders post-head injury. This article provides an overview of other causes of non-positional dizziness post-head trauma from our large institutional experience. The UHN WSIB Neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for those head-injured workers presenting with non-positional peripheral vestibular disorders. All subjects had a detailed neurotological history and examination and vestibular testing including video nystagmography, video head impulse testing (or a magnetic scleral search coil study), vestibular-evoked myogenic potentials, and audiometry. Imaging studies included routine brain and high-resolution temporal bone CT scans and/or brain MRI. Based on a database of 4291 head-injured workers with dizziness, 244 were diagnosed with non-positional peripheral vertigo. Recurrent vestibulopathy (RV) was the most common cause of non-positional post-traumatic vertigo. The incidence of Meniere’s disease in the post-traumatic setting did not appear greater than found in the general population. The clinical spectrum pertaining to recurrent vestibulopathy, Meniere’s disease, delayed endolymphatic hydrops, drop attacks, superior semicircular canal dehiscence syndrome, and uncompensated peripheral vestibular loss are discussed.

Post-traumatic Peripheral Vestibular Disorders (Excluding Positional Vertigo): Institutional Experience from University Health Network’s Workplace Safety and Insurance Board Head-Injury Program

Purpose: Benign paroxysmal positional vertigo has typically been reported to be the most common cause of post-traumatic dizziness. There is however paucity in the literature about other peripheral vestibular disorders post-head injury. This article provides an overview of other causes of non-positional dizziness post-head trauma from our large institutional experience.Methods: The UHN WSIB Neurotology database (n=4,291) between 1998 and 2018 was retrospectively studied for those head-injured workers presenting with non-positional peripheral vestibular disorders. All subjects had a detailed neurotological history and examination and vestibular testing including video nystagmography, video head impulse testing (or a magnetic scleral search coil study), vestibular-evoked myogenic potentials, and audiometry. Imaging studies included routine brain and high-resolution temporal bone CT scans and/or brain MRI.Results: Based on a database of 4,291 head-injured workers with dizziness, 244 were diagnosed with non-positional peripheral vertigo. Recurrent vestibulopathy (RV) was the most common cause of non-positional post-traumatic vertigo. The incidence of Meniere’s disease in the post-traumatic setting did not appear greater than found in the general population. Conclusion: The clinical spectrum pertaining to recurrent vestibulopathy, Meniere’s disease, delayed endolymphatic hydrops, drop attacks, superior semicircular canal dehiscence syndrome, and uncompensated peripheral vestibular loss are discussed.

229Step-downs reduce workers’ compensation payments to encourage return to work. Are they effective?

Background Workers’ compensation systems throughout Australia implement “step-downs,” which cut the amount paid to injured workers after they have received benefits for several months. Though initially introduced to control rising insurance premiums, step-downs are currently justified as an incentive return to work. Whether they have this effect has never been formally tested. Methods Using administrative claims data, we applied a regression discontinuity study design to test whether step-downs affected weekly scheme exit rates, a proxy for return to work, within eight state, territory, and Commonwealth workers’ compensation systems. We also examined effects by injury type (fractures, musculoskeletal, mental health, and other trauma). To derive generalised effects, we combined results using meta-analyses and conducted meta-regressions to determine whether timing or magnitude of step-downs significantly moderated effects. Results Step-downs reduced scheme exit by 0.86 percentage points (95% CI: -1.45, -0.27). Neither timing nor magnitude of step-downs was a significant effect moderator. There were significant effects in fractures (-0.84, 95% CI: -1.61, -0.07) and sensitivity analysis suggested possible effects within mental health and musculoskeletal conditions. Conclusions The negative effects suggest some workers’ compensation recipients anticipate step-downs and return to work early to avoid a reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative. Key messages Reducing the amount of compensation paid to injured workers has a minor incentivising effect on their return to work rates.

Uncovering inefficiencies in the workers’ compensation industry using Lean methodology

PurposeThe purpose of this paper is to apply Lean in the workers’ compensation industry. It focuses on identifying patterns of repetitive non-value-added transnational activities for physical-therapy patients and healthcare providers. It addresses the research gap in this field.Design/methodology/approachIn this study, we designed and deployed multiple case studies to better understand the journey of an injured worker within the worker compensation system in the United States of America. We partnered with Concentra Inc., a leading national healthcare provider in the field of workers’ compensation having 520 medical centers in 44 states. Both case studies included conducting direct observations, Gemba walk, in five clinics in two states: Florida and Pennsylvania. We analyzed the data of 263 injured workers with 8 or more physical therapy visits who got admitted to Concentra clinics in both states over the period of 31 days.FindingsThe results revealed that the time intervals at which activities associated with physical therapy treatment pre-authorization accounted for 91.59% of the total non-value-added activities and are thus the key administrative factor leading to process inefficiency in the state of Florida. The Process Cycle Efficiency of Pennsylvania was 75.36% compared to 53.16% of Florida. The injured workers in Florida needed 39.58 days on average to complete eight physical therapy visits compared to 27.92 days in Pennsylvania (a median of 34.09 vs 22.15 days).Research limitations/implicationsThis study is limited as it only focuses on processes on the healthcare provider side. An expanded value stream map that includes the treatment pre-authorization process on the insurance side would be beneficial for generating more potential solutions to streamline the process.Practical implicationsThis study shows that Lean could play a critical role in identifying and quantifying continuous improvement opportunities that could accelerate patient’s treatment, reduce administrative burden on healthcare providers and improve the overall claim cost of insurance companies. It provides data-driven argument for insurance companies to consider eliminating physical therapy pre-authorization.Originality/valueThis is the first study to apply Lean methodology in the workers’ compensation field.

Injuries and fatalities in Colombian mining emergencies (2005 - 2018)

Background. During the last decades several developed countries reported a decrease in the occurrence of mining injuries. Mining is a very important sector of Colombias economy without analyses of injuries and fatalities in mining emergencies. Objective. This study describes the occurrence of mining emergencies in Colombia between 2005 and 2018, and their principal characteristics. Methods. An ecological study was performed with the mining emergencies registered by the National Mining Agency between 2005 and 2018. The study described the place of occurrence, type of event, legal status and type of mines, mineral extracted, and number of injuries and fatalities. Benfords law was used to explore the quality of the data. Results. A total of 1,235 emergencies occurred, with 751 injured workers and 1,364 fatalities. The majority of emergencies were from collapses, polluted air, and explosions, most of which occurred in coal (77.41%), gold (18.06%), and emerald (1.38%) mines. Many emergencies occurred in illegal mines (27.21%), most of which were gold, construction materials, emerald, and coal. Illegal mines had a higher relative proportion of injuries and fatalities than legal mines (p<0.05). Mining disasters are likely to be underreported given that Benfords Law was not satisfied. Conclusions. Colombia is a country with increasing mining activity, where the occurrence of mining emergencies, injuries, and fatalities is growing. This is the first one full description of mining emergencies in Colombia with the few available data.