Traumatic workplace-related injuries (WRIs) carry a substantial negative impact on the public health worldwide. We aimed to study the incidence and outcomes of WRIs in Qatar. We conducted occupational injury surveillance for all WRI patients between 2010 and 2012. A total of 5152 patients were admitted to the level 1 trauma unit in Qatar, of which 1496 (29%) sustained WRI with a mean age of
Workplace-related traumatic injuries (WRIs) account for a significant proportion of injuries that affect mainly the young population [
Most epidemiological information regarding WRI is derived from developed and industrialized countries. An Australian report on fatal WRI observed 374 deaths, a mortality rate of 1.93 per 100 000 workers, in 2010-2011. Of these, 59% were directly job-related, 29% were transport-related, and 12% were bystander fatalities [
International migrants and migrant workers have contributed significantly to the economic growth and rapid development needs of several countries [
In the Middle East, the majority of fall-related injuries are associated with the construction and petrochemical industries. The rate of fall-related injuries is markedly increased in rapidly developing Middle Eastern countries with increasing demands for construction work. There are only few reports from the Middle East that describe the pattern of injury and safety measures in those who sustained traumatic injuries purely from FHO at the construction sites [
Traumatic injuries cause a major burden on the healthcare system of Qatar. A booming economy and rapid industrialization in Qatar attract thousands of skilled and unskilled workers from South Asia and other countries. The state of Qatar is a rapidly developing, high-income country with a population that is 75% male and is 85% expatriates [
A descriptive analysis of trauma registry data for occupational injury surveillance was conducted; this included all WRI patients admitted at level I Hamad Trauma Center (the national trauma referral center and only provider of tertiary trauma care in Qatar), from January 1, 2010, to December 31, 2012. Labor statistics from the Qatar Statistics Authority were used to compute for the population based incidence and mortality rates from WRI in Qatar [
Based on a mandate from the Supreme Council of Health in Qatar, all emergency medical services (prehospital and in-hospital services) are provided free of charge for all Qatari nationals and residents, including expatriate workers. Moreover, Hamad Medical Corporation is responsible for providing rehabilitation services, free of charge, for all patients until they are discharged home. The majority of migrant workers return to their home countries after serious injuries or disabilities, if they have no family support in Qatar.
To compute for the ISS, each of six anatomical regions was scored with the highest Abbreviated Injury Score (AIS) using the square of the highest value of the three most severely injured body regions. The total score ranged from 1 to 75 [
Ethical approval was obtained from the Medical Research Center (IRB number 13186/13) at Hamad Medical Corporation, Doha, Qatar.
Data were presented as proportions, medians, or mean ± standard deviation (SD), as appropriate. Differences in categorical variables between respective comparison groups were analyzed using Chi-Square test. The continuous variables were analyzed using one-way ANOVA. Two tailed
During the 3-year surveillance, a total of 5152 patients were admitted at the trauma unit, of them 1496 (29%) sustained WRI with a mean age of
Characteristics of injured workers and injuries sustained, Qatar Trauma Registry, 2010–2012.
| |
---|---|
Males | 1458 (97.5) |
Age (mean ± SD; yrs) |
|
Age (range; yrs) | |
<20 | 26 (1.8) |
20–30 | 611 (41.3) |
31–40 | 472 (32) |
41–50 | 240 (16) |
>50 | 130 (9) |
Nationality | |
Nepalese | 437 (29) |
Indian | 307 (21) |
Bangladeshi and Sri Lankan | 238 (16) |
Others | 514 (34) |
Mechanism of injury | |
Fall from height | 761 (51) |
Motor vehicle crash | 248 (16.6) |
Struck by heavy object | 268 (18) |
Machinery | 63 (4) |
Burns | 30 (2) |
Pedestrians (during work) | 34 (2.3) |
Others | 92 (6) |
Type of work | |
Laborers | 632 (42.4) |
Transport | 271 (18) |
Installation/repair | 173 (12) |
Carpenter | 133 (9) |
Housekeeping | 39 (2.6) |
Farming/fishing | 24 (1.6) |
Maintenance, ground cleaning | 21 (1.4) |
Forman | 18 (1.2) |
Others | 185 (12.3) |
No protective measures | 956 (64) |
Injury body region | |
Head | 307 (20.5) |
Chest | 385 (26) |
Lower extremities | 425 (28) |
Upper extremities | 347 (23) |
Abdomen | 276 (18) |
Pelvis | 207 (14) |
Skin and soft tissue injuries | 795 (53) |
Lumbar Spine | 308 (20.6 ) |
Thoracic Spine | 161 (10.8 ) |
Cervical spine | 92 (6.1 ) |
Procedures | |
Open reduction and internal fixation | 407 (27) |
Exploration laparotomy | 87 (6) |
Craniotomy | 44 (3) |
Closed reduction | 73 (5) |
External fixation | 36 (2.4) |
Thoracotomy | 9 (1) |
ICU length of stay (median, range) | 3 (1–64) |
Hospital length of stay (median, range) | 6 (1–192) |
Ventilation days (median, range) | 2 (1–21) |
Rehabilitation needed | 204 (13.6) |
Prehospital death/brought in dead (BID) | 22 (1.5) |
Mortality | 56 (3.7) |
Presentation of injury severity among injured workers.
Mean ± standard deviation | Median; range | |
---|---|---|
Injury severity score |
|
9 (1–75) |
Glasgow coma score (scene) |
|
15 (3–15) |
Head abbreviated injury score |
|
3 (1–5) |
Chest abbreviated injury score |
|
3 (1–5) |
Abdomen abbreviated injury score |
|
2 (1–5) |
Pelvic abbreviated injury score |
|
2 (2–5) |
The overall mortality was 3.7%. Prehospital deaths (BID) constituted 40.5% of all mortalities which included mortality either at the workplace or during transportation to the hospital. The main MOI of BID was FFH (41%) followed by MVCs (23%), FHO, machinery, burn, and pedestrian injuries (9% for each). More young workers died but the case fatality was nonsignificantly higher for older (>50 years) compared to young workers (Figure
Percentage distribution of WRI and case fatality in different age groups.
Table
Case fatality rate and injury and mortality burden based on the mechanism of injury (Trauma Registry, Hamad Trauma Center, Doha, Qatar, 2010–2012).
Fall from height | Motor vehicle crash | Fall of heavy objects | Machinery injury | Burn | Pedestrian injury | |
---|---|---|---|---|---|---|
Injury burden (%)* | 761/1496 (51) | 248/1496 (17) | 268/1496 (18) | 63/1496 (4) | 30/1496 (2) | 34/1496 (2) |
Mortality burden (%)** | 21/56 (38) | 15/56 (27) | 8/56 (14) | 2/56 (4) | 5/56 (9) | 4/56 (7) |
Case fatality rate |
21/761 (3) | 15/248 (6) | 8/268 (3) | 2/63 (3) | 5/30 (17) | 4/34 (12) |
Figure
Percentage distribution of WRI and case fatality according to type of work.
Table
Demography, presentation, and outcome by mechanism of injury.
FFH |
MVC |
FHO |
Machine |
Burns |
Pedestrians |
|
|
---|---|---|---|---|---|---|---|
Males | 735 (96.6) | 244 (98.4) | 267 (99.6) | 62 (98.4) | 27 (90) | 33 (97.1) | 0.02 |
Age (mean ± SD) |
|
|
|
|
|
|
0.72 |
Nationality | 0.001 | ||||||
Nepalese | 235 (30.9) | 51 (20.6) | 85 (31.7) | 21 (33.3) | 8 (26.7) | 14 (41.2) | |
Indian | 146 (19.2) | 55 (22.2) | 56 (20.9) | 10 (15.9) | 9 (30) | 8 (23.5) | |
Bangladeshi | 68 (8.9) | 19 (7.7) | 23 (8.6) | 7 (11.1) | 1 (3.3) | 1 (2.9) | |
Sri Lankan | 39 (5.1) | 25 (10.1) | 27 (10.1) | 9 (14.3) | 3 (10) | 1 (2.9) | |
Pakistani | 26 (3.4) | 27 (10.9) | 12 (4.5) | 3 (4.8) | 1 (3.3) | 0 (0) | |
Philippine | 30 (3.9) | 5 (2) | 9 (3.4) | 5 (7.9) | 2 (6.7) | 4 (11.8) | |
Egyptian | 76 (10) | 19 (7.7) | 18 (6.7) | 2 (3.2) | 2 (6.7) | 1 (2.9) | |
Occupation | 0.001 | ||||||
Laborers | 378 (49.7) | 12 (4.8) | 157 (58.6) | 40 (65.6) | 2 (6.9) | 18 (52.9) | |
Transport | 22 (2.9) | 224 (90.3) | 11 (4.1) | 0 (0) | 1 (3.4) | 2 (5.9) | |
Installation/repair | 91 (12) | 0 (0) | 44 (16.4) | 9 (14.8) | 9 (31) | 4 (11.8) | |
Carpenter | 101 (13.3) | 0 (0) | 22 (8.2) | 4 (6.6) | 0 (0) | 2 (5.9) | |
Housekeeping | 33 (4.3) | 0 (0) | 0 (0) | 0 (0) | 4 (13.8) | 0 (0) | |
Farming/fishing | 14 (1.8) | 0 (0) | 3 (1.1) | 0 (0) | 0 (0) | 0 (0) | |
Maintenance, ground cleaning | 14 (1.8) | 0 (0) | 1 (0.4) | 3 (4.9) | 1 (3.4) | 0 (0) | |
No personal protective equipment (PPE) | 562 (73.9) | 102 (41.1) | 182 (67.9) | 40 (63.5) | 16 (53.3) | 11 (32.4) | 0.001 |
Rehabilitation needed | 107 (14.1) | 37 (14.9) | 47 (17.5) | 2 (3.2) | 1 (3.3) | 5 (14.7) | 0.007 |
Injured body region | |||||||
Head | 183 (24) | 42 (16.9) | 51 (19) | 6 (9.5) | 0 (0) | 7 (20.6) | 0.002 |
Lower extremities | 206 (27.1) | 76 (30.6) | 91 (34) | 20 (31.7) | 0 (0) | 13 (38.2) | 0.001 |
Chest | 210 (27.6) | 80 (32.3) | 56 (20.9) | 4 (6.3) | 0 (0) | 12 (35.3) | 0.001 |
Upper extremities | 201 (26.4) | 67 (27) | 39 (14.6) | 17 (27) | 1 (3.3) | 9 (26.5) | 0.001 |
Abdomen | 139 (18.3) | 62 (25) | 45 (16.8) | 4 (6.3) | 0 (0) | 10 (29.4) | 0.001 |
Pelvis | 114 (15) | 36 (14.5) | 44 (16.4) | 0 (0) | 0 (0) | 9 (26.5) | 0.001 |
Skin/soft tissue injuries | 353 (46.4) | 156 (62.9) | 143 (53.4) | 35 (55.6) | 30 (100) | 54 (76.6) | 0.001 |
Cervical spine | 54 (7.1) | 23 (9.3) | 12 (4.5) | 1 (1.6) | 0 (0) | 1 (2.9) | 0.02 |
Lumbar spine | 223 (29.3) | 24 (9.7) | 52 (19.4) | 0 (0) | 0 (0) | 6 (17.3) | 0.001 |
Thoracic spine | 107 (14.1) | 22 (8.9) | 27 (10.1) | 1 (1.6) | 0 (0) | 3 (8.8) | 0.001 |
ORIF | 211 (27.7) | 80 (32.3) | 82 (30.6) | 11 (17.5) | 0 (0) | 9 (26.5) | 0.001 |
Exploration laparotomy | 31 (4.1) | 26 (10.5) | 17 (6.3) | 1 (1.6) | 0 (0) | 5 (14.7) | 0.001 |
Injury severity score (mean ± SD) |
|
|
|
|
— |
|
0.001 |
Intensive care unit days (median, range) | 3 (1–52) | 4 (1–36) | 3 (1–59) | 2 (1–5) | 11 (1–64) | 3.5 (1–22) | 0.04 |
Hospital LOS (median, range) | 6 (1–132) | 7 (1–192) | 7 (1–154) | 4 (1–44) | 9 (1–84) | 6 (1–90) | 0.004 |
Ventilation days (median, range) | 2 (1–19) | 2 (1–15) | 2 (1–21) | 2 (1-2) | 2 (1–13) | 1 (1–16) | 0.87 |
Glasgow coma score (mean ± SD) |
|
|
|
|
|
|
0.06 |
Brought in dead | 9 (1.2) | 5 (2) | 2 (0.7) | 2 (3.2) | 2 (6.7) | 2 (5.9) | 0.02 |
Mortality | 21 (2.8) | 15 (6) | 8 (3) | 2 (3.2) | 5 (16.7) | 4 (11.8) | 0.001 |
MVC: motor vehicle crash; FFH: fall from height, FHO: struck by heavy object; ORIF: open reduction and internal fixation; ISS: injury severity score; LOS: length of stay; Chi-Square test (categorical variables); one-way ANOVA (continuous variables).
This is the first report of occupational injury surveillance data to describe the epidemiology and outcome of serious WRI in Qatar. The analysis is based on the trauma registry of the only level I Trauma Center in Qatar; it is an accurate representation of all serious WRIs that occur in the country because all such cases are transferred to our center. The incidence and death rates of WRI in Qatar are much lower than the published reports from other similar countries in the region.
WRI represents a significant health and economic concern worldwide. However, the evaluation of the global burden of WRI and diseases remains challenging. In particular, developing nations lack reliable information on WRI which is mainly attributed to the limited resource allocation, negligence, and underreporting [
According to the International Labor Organization (ILO), the global mortality (2008) from fatal occupational accidents was 321,000 [
Reports from USA showed a similar incidence of WRI in the high-risk Hispanic workers in Massachusetts (54.8 per 100,000 workers per year) and Washington State (45.5 per 100,000 workers per year) [
The Hamad Trauma Unit admitted about 5152 trauma patients over a 3-year period, of them WRI comprises 29% of the total admissions. Over a 10-year period, data from Washington State Trauma Registry in USA showed that WRI formed only 7.3% of all trauma admissions [
Several epidemiological studies have observed a higher incidence of WRI among young males [
In the present study, the most common MOI was FFH. Barss et al. reported the same experience in the UAE where 51% of their WRI patients were victims of falls from height, 29% of which were from considerable height [
The proportion of WRI occurring in laborers and installation/repairmen contrasts with the findings of Mock et al. from Ghana [
Although, work-related burn injuries in our series were only 2% of all WRI, 17% of burn victims died and they constituted 9% of mortalities. Unfortunately, our database was unable to document the extent, grade, type, associated traumatic injuries, and cause of death among burn-related causalities. Analysis based on MOI also revealed that among housekeeping workers the percent of injuries due to burns was high and further analysis of the higher rate of deaths among these workers is needed to identify opportunities for improvements in primary, secondary, and/or tertiary prevention of burns-related deaths and injuries.
Data from the National Census of Fatal Occupational Injuries (2012) showed highest mortality among transportation incidents (41%), of which 16% involved pedestrians who were struck by vehicles [
The overall case fatality was 3.7%, with the most fatalities from falls and the highest lethality being related to burn and pedestrians injuries at work. The variability in the mortality patterns by MOI and occupation can be attributable to differential exposures (i.e., housekeeping →kitchen →fires →burns versus road construction work →road exposure →pedestrian injury). The higher incidence of these potentially preventable injuries can be attributed to the lack of stringent safety regulations, consistent enforcement of these regulations, and the proper orientation and training of the expatriate workers. Our study confirmed this, as only 36% of WRI patients used PPE, while the remaining injured workers were not in compliance with safety regulations in the workplace. Also, the mortality was nonsignificantly higher among older workers as compared to other age groups. Our findings are supported by an earlier report from Centers for Disease Control and Prevention which showed that the mortality rates were higher among workers involved in transportation and material moving. Particularly, older workers (≥65 yrs) constituted a higher percentage (23%) of deaths [
In contrast to figures from the National Census of Fatal Occupational Injuries, victims of workplace violence did not make up a significant proportion of our patients with WRI.
Interestingly, our study observed an increased need for ventilatory support and prolonged ICU stay of WRI cases which reflects the severity of injury and financial burden on the healthcare system.
There are several limitations and areas for recommended improvement in our study such as underrepresentation of minor WRI as the trauma registry only encodes data from patients with severe injury or polytrauma, underreporting of protective measures used, deficient detailed medical history of patients, lack of data about medical insurance issues, work place ergonomics, work site environment, and employers’ details (both private and public sectors). Also, language barriers represented a major limitation for medical staff communication with patients and subsequently the accuracy of documentation. Further, while our trauma registry data is prospectively encoded, retrospective exploration of this database shows that it still lacks certain WRI-specific data elements that are needed to fully inform policies and programs for occupational safety in Qatar. The creation of an integrated occupational injury registry with sources of data from the ambulance, emergency, hospital, and rehabilitation services in collaboration with the Ministry of Labor and insurance companies will mitigate the shortcomings of our present occupational surveillance system.
This study identified the most common and lethal mechanisms of WRI in Qatar.
FFH should be the focus of primary prevention efforts based on their high mortality and injury burden. Burn injuries in housekeeping workers, MVCs, and pedestrian injuries are other areas for prioritization.
Future research should focus on improving the quality of data on occupational injuries in Qatar. The creation of a dedicated multidisciplinary task force that will prospectively collect all data on risk factors and outcomes for WRI and link these with incident investigations from the Ministry of Labor is the first step needed. The investigation of the relationship between chronic conditions, the incidence and cost of WRI among high-risk occupations, workplace violence, and recurrent workplace injuries could be some of the priority issues this dedicated occupational injury registry will address. Therefore, occupational health and safety should be specifically tailored for the workers involved in most hazardous occupations and vulnerable groups. Strict governance from the Ministry of Labor is required to ensure compliance with safety measures as well as necessary precautions to avoid health risks from WRI in the workplace. There is an urgent need to improve the quality of data regarding WRIs in the rapidly developing high-income countries of the Middle East in order to ensure that progress is sustained but not at the expense of worker health and welfare. We also recommend the need for multiagency review of health provision for migrant workers, which should be based on thorough and independent evaluation for the major causes of mortality among migrant construction workers and identifying key measures to improve health and safety of workers in Qatar.
In conclusion, although the incidence of WRI in Qatar is quite substantial, its mortality rate is relatively low in comparison to other countries of similar socioeconomic status. The implementation and enforcement of strict safety regulations and use of PPE should be mandatory in workplaces, particularly in construction industry. WRIs cause a significant socioeconomic burden as evidenced by their extended length of hospital stay and prevalent need for rehabilitation services. The authors call for better evidence on the risk factors for WRI which must be used to formulate and implement focused injury prevention programs in the populations and industries identified to be at the highest risk for WRI.
The authors have no conflict of interests.
All authors contributed to the creation of the paper and approved it.
The authors thank all the Trauma Surgery staff and database registry for their kind cooperation.