O-173 VALIDATION OF AN OCCUPATIONAL MUSCULOSKELETAL DISEASES REFERRAL SYSTEM

Abstract Introduction Referral mechanism among clinical physicians and occupational physicians is important for diagnosis of occupational diseases(ODs). Previous study identified criteria additional to ICD codes to enhance positive predictive value by comparing demographic factors between probable cases and possible/non-related cases. We further aim to apply these predictors of work-relatedness in clinical trials to develop a validated screening tool and strengthen the referral system. Methods In Taiwan, Network of Occupational Diseases and Injuries Service(NODIS) is an important surveillance system of ODs. In NODIS, musculoskeletal diseases (MSDs) are the most reported cases. Among adult patients who visited OPD of Orthopedic and Rehabilitation, we screen those with diagnoses of MSD ICD codes. Selected patients are invited to OPD of Occupational Medicine, where informed consent is obtained and a physician-guided questionnaire is conducted. Patients eligible for ODs are reported in NODIS and we analyze demographic factors between probable cases and possible/non-related cases. Results There are 4651 confirmed cases of occupational MSDs, and 62.37% (2901/4651) cases are classified as probable cases. In binomial regression model, longer tenure, ever taking leaves due to MSDs, construction and manufacturing industries and main MSDs in OD list are all significant predictors of work-relatedness. Discussion and Conclusion Each MSD has its unique predictor of work-relatedness, and we identify high-risk characteristics, like age, gender, tenure, industry, sick leave status. Using each predictor’s coefficient, we generate a set of referral criteria to refer cases with odds ratio of 2 or above, which enables better referral mechanism. Through trial validation, we identify significant factors which can be incorporated in occupational MSDs screening and referral mechanism.