Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #99700

Bradley Evanoff, MD, MPH, Division of General Medical Sciences, Washington University School of Medicine, Campus box 8005, 660 South Euclid Ave, St. Louis, MO 63110, Steven Kymes, PhD, MHA, Department of Ophthalmology, Washington University School of Medicine, Campus Box 8096, 660 South Euclid Ave., St. Louis, MO 63110, and Scott Steiger, MD, Department of Internal Medicine, University of Washington, 1959 NE Pacific, Box 356421, Seattle, WA 98195, (206) 375-8840, steiger@u.washington.edu.

Workers with abnormal median nerve conduction studies are at increased risk of developing carpal tunnel syndrome (CTS). Court decisions in the United States have established the legality of excluding workers from jobs based on the results of pre-employment nerve conduction testing. The only published study of this practice found that one employer gained no cost benefit from screening.

We modeled the preventive effectiveness of pre-employment screening for CTS. Workers with median nerve conduction abnormalities were not hired in our model. Values for model inputs were derived from existing literature.

In our baseline model, total employer costs for CTS (cost of screening plus cost of workers' compensation CTS cases) were higher when screening was used ($166.72 vs. $71.88). Sensitivity analyses showed that screening provided a cost benefit to the employer only under limited circumstances and required a high annual incidence of CTS among the worker population. For each case of CTS prevented, 43 workers were rejected; most would not have developed CTS.

Using Monte Carlo simulation, we tested 10,000 randomly selected permutations of the model inputs throughout their ranges. A strategy of not screening was favored in 70-90% of simulations, depending on model assumptions.

Screening may reduce CTS costs for some employers, but probably does not reduce societal costs of CTS. We conclude that for most employers screening for CTS is not appropriate. Application of the decision analysis techniques such as those used in this study can be used to evaluate other practices in occupational health.

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