Evaluation and Treatment of the Acutely Injured Worker



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Am Fam Physician. 2014 Jan 1;89(1):17-24.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz Questions.

Author disclosure: No relevant financial affiliations.

Approximately 3 million work-related injuries were reported by private industries in 2011, and primary care physicians provided care for approximately one out of four injured workers. To appropriately individualize the treatment of an injured worker and expedite the return to work process, primary care physicians need to be familiar with the workers' compensation system and treatment guidelines. Caring for an injured worker begins with a medical history documenting preexisting medical conditions, use of potentially impairing medications and substances, baseline functional status, and psychosocial factors. An understanding of past and current work tasks is critical and can be obtained through patient-completed forms, job analyses, and the patient's employer. Return to work in some capacity is an important part of the recovery process. It should not be unnecessarily delayed and should be an expected outcome communicated to the patient during the initial visit. Certain medications, such as opioids, may delay the return to work process, and their use should be carefully considered. Accurate and legible documentation is critical and should always include the location, date, time, and mechanism of injury.

The evaluation and treatment of the injured worker has become a common challenge in the practice of medicine. In 2011, about 3 million workplace injuries were reported in private industries.1 More than one-half of these involved an injury severe enough that work restrictions, job transfer, or time off from work was required.1 The occupations with the most injuries requiring time off were laborers (construction trades), nursing aides/attendants, and janitors/cleaners.2 Persons 45 to 54 years of age had the highest incidence of injuries, with sprains, strains, and tears the most common diagnoses, accounting for 38% of all injuries requiring time off work.2 The back (36%), shoulder (12%), and knee (12%) were most often injured.2 In 2007, the costs for workers' compensation care in the United States was approximately $50 billion, about four times the cost of breast cancer treatment.3

Occupational medicine is one of the smallest medical specialties, producing about 130 board-eligible physicians annually.4 With the shortage of occupational medicine specialists, primary care physicians are often tasked with evaluating injured workers. Overall, 25% of patients with work-related conditions are cared for by primary care physicians, providing nearly three times as many visits for injured workers compared with occupational medicine specialists.5

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

Psychosocial factors should be assessed in the injured worker because they may significantly affect recovery.

C

6, 13, 14, 2123

A detailed occupational history should be obtained when evaluating the injured worker.

C

6, 13, 25

Patients with work-related injuries should be educated on their diagnosis, treatment, and prognosis.

C

6, 23, 2931

Prompt and appropriate return to work improves outcomes in work-related injuries.

C

6, 27

Opioids and other impairing medications should be used cautiously in injured workers because they may prolong recovery and prohibit return to work.

C

6, 35, 36


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

View Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

Psychosocial factors should be assessed in the injured worker because they may significantly affect recovery.

C

6, 13, 14, 2123

A detailed occupational history should be obtained when evaluating the injured worker.

C

6, 13, 25

Patients with work-related injuries should be educated on their diagnosis, treatment, and prognosis.

C

6, 23, 2931

Prompt and appropriate return to work improves outcomes in work-related injuries.

C

6, 27

Opioids and other impairing medications should be used cautiously in injured workers because they may prolong recovery and prohibit return to work.

C

6, 35, 36


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Evaluation

The evaluation of the injured worker extends beyond determining an appropriate diagnosis and treatment plan. The evaluation also assesses

The Authors

GREG VANICHKACHORN, MD, MPH, is the medical director for the Occupational Health Services Clinic at Kalispell (Mont.) Regional Healthcare.

BRAD A. ROY, PhD, FACSM, FACHE, is an administrator/executive director at Kalispell Regional Healthcare. He is responsible for the Summit Medical Fitness Center, Occupational Health Services Clinic, and a number of other hospital departments.

RITA LOPEZ, MSN, APRN-BC, is a nurse practitioner in the Occupational Health Services Clinic at Kalispell Regional Healthcare.

REBECCA STURDEVANT, MSN, APRN-BC, is a nurse practitioner in the Occupational Health Services Clinic at Kalispell Regional Healthcare.

Address correspondence to Greg Vanichkachorn, MD, MPH, Kalispell Regional Healthcare, 205 Sunnyview Ln., Kalispell, MT 59901 (e-mail: gvanichkachorn@krmc.org). Reprints are not available from the authors.

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