Clinical correlates of workplace injury occurrence and recurrence in adults

Zhaoyi Chen; Mattia Prosperi; Jiang Bian; Jae Min; Mo Wang; Chang Li

doi:10.1371/journal.pone.0222603

Peer Review History

Original SubmissionJuly 30, 2019
13 Aug 2019 Decision Letter - Yu Ru Kou, Editor PONE-D-19-21474 Clinical correlates of workplace injury occurrence and recurrence in adults PLOS ONE Dear Chen, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Both reviewers had several concerns, especially regarding the definition of the study groups and statistical analysis. I hope that the authors can effectively respond to their comments in the revised manuscript. We would appreciate receiving your revised manuscript by Sep 27 2019 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Major revision 1.If one patient had a workplace injury, injury at other places, and without injury information in database. Which group did the patient belong to? 2.If one patient had more than two workplace injuries, which injury was selected in this study? 3.This study only matched on the distribution of diagnosis year, and why basic demographic data (gender, age, and race) not included in the matching criteria? Reviewer #2: The study by Chen et al. is a case-control study combining three different databases and discussing the morbidities associated with workplace injury. They compared the characteristics of three groups include workplace injury, injury at other places and controls; concluding that WPI can lead to serious physical comorbidity burdens. They also built prediction models for injury recurrences, identifying several risk factors. I have some comments as below: 1. In this study, workplace injury (WPI) was defined by ICD-9 diagnostic code E849.3, while diagnoses codes E849.0 to E849.9 except E849.3 were defined as injuries at other place (IOP). In general practice of occupational medicine, E849.2 (Mine and quarry accidents), E849.1 (Farm accidents) and even E849.9 (Accidents occurring in unspecified place) could also be used to describe WPI. Based on current definition, I think some WPI were actually included in IOP. This might affect your following models. 2. Since you have used ICD-9 code to define WPI group, how did you define the status of WPI recurrence. Please describe the detail in methods. 3. I suggest a better work to explain the relative low model performance and the variables that negatively associated with WPI (such as chronic pulmonary heart disease HR 0.33). 4. In the current study, you found that WPI were more likely to be admitted for acute bronchitis and bronchiolitis (ICD-9: 466). And you suggested that this could be related to COPD of occupational exposure. However, to our knowledge, occupational exposure related COPD was mostly in presence of chronic bronchitis instead of the ICD-9:466 you indicated. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0222603.r001
Revision 1
22 Aug 2019 Author Response Dear editor, thanks for considering our manuscript; we appreciated the reviewers’ feedback. We updated our manuscript in accordance to their suggestions, and prepared a line-by-line response letter showing the revisions made. 1. If one patient had a workplace injury, injury at other places, and without injury information in database. Which group did the patient belong to? Re: As long as a patient had one WPI, it is assigned to the WPI group. If any IOP occurred before, it is accounted for as a possible predictor. We now have clarified the process in the Methods section. 2. If one patient had more than two workplace injuries, which injury was selected in this study? It is the first recorded in the data base; the criterion is now stated in the Methods. 3. This study only matched on the distribution of diagnosis year, and why basic demographic data (gender, age, and race) not included in the matching criteria? Re: Because it was of interest to describe --if any-- the demographic differences. In fact, we did find differences in these variables between WPI and the comparison groups. We reckon that IOP and WPI could be different among age groups because of the employment ages. Nonetheless, we included only adult individuals, so the putative bias might be only among younger (not yet employed) or older (retired) people. The Discussion sections now contains additional and more detailed considerations in this regard. Reviewer #2: 1. In this study, workplace injury (WPI) was defined by ICD-9 diagnostic code E849.3, while diagnoses codes E849.0 to E849.9 except E849.3 were defined as injuries at other place (IOP). In general practice of occupational medicine, E849.2 (Mine and quarry accidents), E849.1 (Farm accidents) and even E849.9 (Accidents occurring in unspecified place) could also be used to describe WPI. Based on current definition, I think some WPI were actually included in IOP. This might affect your following models. Re: The reviewer was right and indeed we had included mine/quarry/farms accidents in the WPI group, and we clarified it in the methods. Thanks for pointing this out. We also discussed that an alternative categorization into IOP could be legit because they are not explicit. These codes are also not explicitly WPI –some of them might not be WPI– and this was the main reason we debated when we design the study on whether to keep them in or out; there would be misclassifications either way. We have checked the frequency of the corresponding ICD codes in the whole sample, and have reported them in the revised manuscript. The frequencies of these codes were rather low, thus, the potential misclassification of these code would have little impact on the overall study results (bearing the possibility of specific morbidities associated to these two injuries). We have updated the Discussion acknowledging this matter. 2. Since you have used ICD-9 code to define WPI group, how did you define the status of WPI recurrence. Please describe the detail in methods. Re: WPI recurrence is defined as any WPI diagnosis recorded at least 30 days after the first WPI diagnosis. We decided to use a time window because a WPI diagnosis within the time window could have been a readmission for the same injury. The Centers for Medicare & Medicaid Services (CMS) define a hospital readmission as "an admission to an acute care hospital within 30 days of discharge from the same or another acute care hospital.”. We have added these details in Methods. 3. I suggest a better work to explain the relative low model performance and the variables that negatively associated with WPI (such as chronic pulmonary heart disease HR 0.33). Re: The low model performance is likely due to the fact that prior clinical history and demographics may not be the most informative domains to predict risk of WPI, although extant theory incorporates mental health disorders and drug dependence as predictors (which can be ascertained by prior ICD diagnoses), and there is likely racial disparity. However, predictors that could explain a larger portion of variance include job type, workplace safety, physical stress, et cetera, which are not present in the HCUP data base. We have rewritten part of our Discussions section to better explain these other –unmeasured– contributors to overall risk. 4. In the current study, you found that WPI were more likely to be admitted for acute bronchitis and bronchiolitis (ICD-9: 466). And you suggested that this could be related to COPD of occupational exposure. However, to our knowledge, occupational exposure related COPD was mostly in presence of chronic bronchitis instead of the ICD-9:466 you indicated. Re: the reviewer is right in reporting the association more likely with chronic bronchitis rather than acute. There is a number of possible explanations to this: 1) being this the first WPI, a diagnosis of chronic bronchitis might not have been made yet; 2) our population includes both routine care and acute care, i.e. emergency rooms and urgent care centers, where an attack of bronchitis would be diagnosed as acute even in presence of an underlying condition; 3) possible selection bias, i.e. people with chronic bronchitis have increased risk to be in care regardless the injury type, but acute episodes are differently distributed. We have added another paragraph in the Discussion accordingly. https://doi.org/10.1371/journal.pone.0222603.r002
4 Sep 2019 Decision Letter - Yu Ru Kou, Editor [EXSCINDED] Clinical correlates of workplace injury occurrence and recurrence in adults PONE-D-19-21474R1 Dear Dr. Chen, We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. 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With kind regards, Yu Ru Kou, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: My major concern was the definition of the study groups. The authors had modified the definition and provided detailed results in the revision. All the comments have been addressed. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No https://doi.org/10.1371/journal.pone.0222603.r003
Formally Accepted
6 Sep 2019 Acceptance Letter - Yu Ru Kou, Editor PONE-D-19-21474R1 Clinical correlates of workplace injury occurrence and recurrence in adults Dear Dr. Chen: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Yu Ru Kou Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0222603.r004

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