Work-related ladder fall fractures: identification and diagnosis validation using narrative text.

Objective: To identify ladder-related fracture injuries and determine how ladder fall fractures differ from other ladder-related injuries.

Methods: Ladder-related fracture cases were identified using narrative text and coded data from workers' compensation claims. Potential cases were identified by text searches and verified with claim records. Injury characteristics were compared using proportionate injury ratios.

Results: Of 9826 ladder-related injuries, 7% resulted in fracture cases. Falls caused 89% of fractures and resulted in more medical costs and disability days than other injuries. Frequent mechanisms were ladder instability (22%) and lost footing (22%). Narrative text searches identified 17% more fractures than injury codes alone. Males were more likely to sustain a fall fracture than other injuries; construction workers were most likely, and retail workers were the least likely to sustain fractures.

Conclusions: Fractures are an important injury from ladder falls, resulting more serious consequences than other ladder-related injuries. Text analysis can improve the quality and utility of workers compensation data by identifying and understanding injury causes. Proportionate injury ratios are also useful for making cross-group comparisons of injury experience when denominator data are not available. Greater attention to risk factors for ladder falls is needed for targeting interventions.