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A case-crossover study of occupational hand injuries: A review of the literature, application, and nested reliability study

David Alphonse Lombardi, University of Massachusetts Amherst


Injury epidemiology, a relatively new sub-discipline of epidemiology, has continued to evolve since the ground-breaking work by Dr. William Haddon during the 1960s. The case-crossover design is a relatively new epidemiological methodology developed specifically for investigating the transient effects of a brief exposure on the onset of an acute outcome. This dissertation work provides some initial empirical data illustrating the strengths and limitations of the case-crossover design as applied within the field of occupational injury epidemiology. The review of the literature details the utility of the case-crossover study design, the currently known strengths and limitations, and confirms the under-utilization of this design to date. Examples from an on-going multi-center, interview-based, case-crossover study of acute traumatic occupational hand injuries are utilized to highlight some of the strengths and weaknesses of this new method, as applied to injury research. The application demonstrates the importance of temporal factors in determining the etiology of occupational acute traumatic hand injury. The findings point out the need to know more about the timing of high risk work tasks and transient exposures throughout the work day. These factors should be taken into consideration when developing intervention strategies for the prevention of hand injuries in the workplace. To evaluate the potential impact of information bias on the results of this study, a reliability study was also conducted. The findings from this test-retest study suggest that the frequency and duration of unusual transient workplace exposures, occurring proximal to the time of an injury, can be reliably recalled using a telephone interview.

Subject Area

Public health|Occupational safety

Recommended Citation

Lombardi, David Alphonse, "A case-crossover study of occupational hand injuries: A review of the literature, application, and nested reliability study" (2001). Doctoral Dissertations Available from Proquest. AAI3000319.