*Article* **The Epidemiology, Cost, and Occupational Context of Spinal Injuries Sustained While 'Working for Income' in NSW: A Record-Linkage Study**

**Lisa N. Sharwood 1,2,3,\*, Holger Mueller 4, Rebecca Q. Ivers 4,5, Bharat Vaikuntam 1,2, Tim Driscoll <sup>6</sup> and James W. Middleton 1,2,7**


Received: 8 September 2018; Accepted: 23 September 2018; Published: 27 September 2018

**Abstract:** This study aimed to describe the epidemiological characteristics, the occupational context, and the cost of hospitalised work-related traumatic spinal injuries, across New South Wales, Australia. A record-linkage study of hospitalised cases of work-related spinal injury (ICD10-AM code U73.0 or workers compensation) was conducted. Study period 2013–2016. Eight hundred and twenty-four individuals sustained work-related spinal injuries; 86.2% of whom were males and had a mean age of 46.6 years. Falls led to 50% of the injuries; predominantly falls from building/structures, ladders or between levels. Falls occurred predominantly in the construction industry (78%). Transport crashes caused 31% of injuries and 24% in heavy vehicles. Half of all the transport injuries occurred 'off road'. The external cause was coded as 'non-specific work activity' in 44.5% of cases; missing in 11.5%. Acute care bed days numbered at 13,302; total cost \$19,500,000. High numbers of work-related spinal injuries occurred in the construction industry; particularly falling from a height. Off-road transport-related injuries were significant and likely unaddressed by 'on-road' prevention policies. Medical record documentation was insufficient in injury mechanism and context specificity. Workers in the construction industry or those using vehicles off-road were at high risk of spinal injury, suggesting inefficient systems approaches or ineffective prevention policies. Reducing the use of non-specific external cause codes in patients' medical records would improve the measurement of policy effectiveness.

**Keywords:** workplace injuries; spinal trauma; record-linkage data
