Extended work duration and the risk of self-reported percutaneous injuries in interns
Extended work duration and the risk of self-reported percutaneous injuries in interns
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DOI：
10.1001/jama.296.9.1055
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发表时间：
2006-09-06
影响因子：
120.7
通讯作者：
Czeisler, Charles A.
中科院分区：
文献类型：
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作者：
Ayas, Najib T.;Barger, Laura K.;Czeisler, Charles A.
在研究生培训的第一年，实习生通常轮班工作时间超过24小时。长时间的轮班与车祸的风险增加有关，尤其是在上下班的路上。实习生可能面临其他职业相关伤害的风险。目的评估美国不同实习人群中工作时间延长与经皮损伤发生率之间的关系。设计、环境和参与者：从2002年7月到2003年5月，在美国研究生住院医师项目中约有18447名实习生，其中2737人参与了一项全国前瞻性队列研究。每个月，向所有参与者发送有关工作时间表和上个月经皮损伤发生情况的综合网络调查。进行了病例交叉分析。主要结局指标：夜班（延长工作时间）后白天工作（上午6:30至下午5:30）期间与白天工作之前没有夜班（非延长工作时间）期间经皮损伤发生率的比较。我们还比较了夜间（晚上11:30到早上7:30）和白天（早上7:30到下午3:30）的受伤情况。结果每月调查17 003次，共报告经皮损伤498例（0.029例/实习月）。在448例损伤中，至少有1个因素被报道。注意力不集中和疲劳是两个最常见的因素（分别占伤害的64%和31%）。与非延长工作时间相比，延长工作时间更容易发生经皮损伤（分别为1.31/1000 vs 0.76/1000）；优势比[OR]为1.61；95%可信区间[CI]为1.46-1.78)。在平均连续工作29.1小时后发生的长时间工伤；非长期工伤发生在平均连续工作6.1小时之后。夜间受伤比白天更频繁（分别为1.48/1000 vs 0.70/1000）； OR为2.04；95% CI为1.98-2.11)。结论：在本研究的第一年临床培训医师中，延长工作时间和夜间工作与经皮损伤风险增加有关。
Context In their first year of postgraduate training, interns commonly work shifts that are longer than 24 hours. Extended-duration work shifts are associated with increased risks of automobile crash, particularly during a commute from work. Interns may be at risk for other occupation-related injuries.Objective To assess the relationship between extended work duration and rates of percutaneous injuries in a diverse population of interns in the United States.Design, Setting, and Participants National prospective cohort study of 2737 of the estimated 18 447 interns in US postgraduate residency programs from July 2002 through May 2003. Each month, comprehensive Web-based surveys that asked about work schedules and the occurrence of percutaneous injuries in the previous month were sent to all participants. Case-crossover within-subjects analyses were performed.Main Outcome Measures Comparisons of rates of percutaneous injuries during day work (6:30 AM to 5:30 PM) after working overnight (extended work) vs day work that was not preceded by working overnight (nonextended work). We also compared injuries during the nighttime (11:30 PM to 7:30 AM) vs the daytime (7:30 AM to 3:30 PM).Results From a total of 17 003 monthly surveys, 498 percutaneous injuries were reported (0.029/intern-month). In 448 injuries, at least 1 contributing factor was reported. Lapse in concentration and fatigue were the 2 most commonly reported contributing factors (64% and 31% of injuries, respectively). Percutaneous injuries were more frequent during extended work compared with nonextended work (1.31/1000 opportunities vs 0.76/1000 opportunities, respectively; odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.78). Extended work injuries occurred after a mean of 29.1 consecutive work hours; nonextended work injuries occurred after a mean of 6.1 consecutive work hours. Injuries were more frequent during the nighttime than during the daytime (1.48/1000 opportunities vs 0.70/1000 opportunities, respectively; OR, 2.04; 95% CI, 1.98-2.11).Conclusion Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training.