Can emergency physicians predict severity and time away from work?

Emergency and primary care physicians are often asked to estimate patients' likely duration of sickness absence or temporary disability following work-related injury or illness. However, return to work is a complex interaction of multiple factors and often difficult to predict accurately.

To compare physician estimates of expected time away from work and severity of injury, made at the time of the initial presentation, with actual duration of temporary disability following work-related shoulder or knee injury.

Patients aged 18-65 with work-related shoulder or knee injuries who attended one of three Edmonton Emergency Departments were recruited. For each participant the treating physician made an estimate of severity and expected time before they would return to their work. This was compared with information on actual temporary disability (TDdays) obtained from the Alberta Workers' Compensation Board (WCB) data.

Over the study period, 443 (88%) of 501 patients were enrolled into the study; however, only 177 (35%) agreed to linking their data with WCB. Median TDdays increased with the physicians' estimates of both severity and likely temporary disability. Physicians tended to underestimate time off work for those with long duration of TDdays, but overestimated this for those with short durations.

Emergency physicians' estimates of expected lost work time and severity of injury were correlated with actual temporary disability, although their accuracy was fairly low. Further work to define why differences between estimated and actual temporary disability occur could help physicians and others planning return to work.