Can Emergency Physicians accurately estimate time to return to normal work following work related injury?

Introduction
Physicians often estimate a likely period of temporary disability for a patient following work-related illness/injury. However, return to normal work is dependent on many factors and may be difficult to predict. We compared emergency physicians’ estimates of likely temporary disability with actual days of temporary disability (TDdays).

Methods
Patients with work-related shoulder or knee injuries attending Emergency Departments in Edmonton, Canada, were prospectively recruited. Data on the injury were collected at the time of initial attendance. The physician's assessment of injury severity using a visual analogue scale (from 0 (least severe) - 100 (most severe)), and estimated temporary disability were collected at the same time. TDdays were obtained from Workers' Compensation Board records. Estimates of severity and estimated temporary disability were categorised into three groups (low, medium, high) for comparison with TDdays.

Results
107 participants with knee and 70 with shoulder injury were recruited. Injuries comprised: 105 'strain/sprain/ tear' injuries; 43 surface injuries; 25 fracture/dislocations; and, 4 other. Median severity score was 26 (interquartile range (IQR): 16-49). Median estimated temporary disability was 5 days (IQR: 3-10), mean 9 days(standard deviation (SD) 12). Median TDdays was 2 days (IQR: 0-25), mean 27 days (SD 57) . Median TDdays increased with severity score: low severity: TDdays = 0; moderate severity: TDdays = 4; high severity: TDdays = 13 (p 0.006). Similarly median actual TDdays increased with estimated temporary disability: low estimated temporary disability: TDdays = 1; medium: TDdays = 0; high: TDdays = 25 (p 0.001). Actual TDdays were significantly different than estimated temporary disability (p <0.001)

Discussion
At the time of first assessment Emergency Physicians can estimate relative severity and likely temporary disability with some accuracy; however, they tend to underestimate time to return to normal work as TDdays increases.