Using Injury Severity to Improve Occupational Traumatic Injury Trend Estimates

Details

• Personal Author:
  Hogg-Johnson S ; Sears JM
• Description:
  Acute work-related trauma is a leading cause of death and disability among U.S. workers, and is very costly for injured workers, employers, workers' compensation (WC) systems, and society as a whole. Accurate characterization of injury trends is critical to prevention planning and evaluation. This study investigated methods to improve injury trend estimation and produced information and tools directly useful for occupational injury surveillance and research. Findings fell into several substantive areas. First, the importance of severity restriction as a surveillance methodology was assessed using hospital discharge data from the National Hospital Discharge Survey and four states. Trend estimates were generally biased downward in the absence of severity restriction, more so for occupational than non-occupational injuries. Restriction to severe injuries provided a markedly different overall picture of trends. Severity restriction may minimize sources of temporal bias such as increasingly restrictive hospital admission practices, constricting WC coverage, and decreasing identification/reporting of minor work-related injuries. Second, a list of severe injury ICD-9-CM diagnosis codes was developed for surveillance purposes, and validated using Washington State Trauma Registry (WTR) data linked with WC data. Classification as a severe injury was a significant predictor of trauma registry inclusion, early hospitalization, compensated time loss, total permanent disability, and total medical costs. The severe injury list provides a simple and transparent alternative to injury severity estimation using proprietary software. Third, hospital discharge data from five states were used to calculate rates and trends for work-related injury hospitalizations, and substantial racial/ethnic disparities were documented. Fourth, there was substantial concordance between WTR and hospital discharge data for priority data fields, including payer, race/ethnicity, severity, and ICD-9-CM external cause of injury codes (E-codes). E-code based methods of identifying occupational injuries had high specificity (> 99%) but low sensitivity (< 14%). WC as payer was 76% sensitive and 98% specific. Many work-related injuries could not be identified using hospital discharge records. Fifth, occupational injury trends were substantially similar whether estimated using trauma registry or hospital discharge data. Rate estimates differed by data source, and were most similar when using a severity threshold. A mature state trauma registry with mandatory reporting can be used as an alternative to hospital discharge data for surveillance of severe work-related traumatic injuries, but incidence will be underestimated using either source. The primary translation achievement was a new Occupational Health Indicator (OHI) for state-based occupational injury surveillance. OHI #22 "Work-Related Severe Traumatic Injury Hospitalizations" has been adopted by the Council of State and Territorial Epidemiologists (CSTE). This study produced evidence that severity restriction is an important enhancement to injury surveillance methodology. More accurate trend estimates can be used by occupational health researchers, practitioners, and policy-makers to identify prevention opportunities and support investment in prevention efforts. This study demonstrated disparities in occupational injury rates in multiple states. This study also contributes to understanding the strengths and limitations of trauma registry and hospital discharge data. Finally, the severe injury list can be used to enhance occupational injury research, such as to control for confounding in program evaluation and outcome studies. [Description provided by NIOSH]
• Subjects:
  Delivery Of Health Care Epidemiology Occupational Health Risk Assessment Risk Factors Safety
• Keywords:
  Injuries Lost Work Days Medical Care Medical Records Risk Factors Surveillance Programs Traumatic Injuries Workers Compensation
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  OSHA Region 10 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-59
• NIOSHTIC Number:
  nn:20053560
• NTIS Accession Number:
  PB2019-100317
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R21-OH-010307, 2015 Oct; :1-59
• Contact Point Address:
  Jeanne M. Sears, Box 357660, Department of Health Services, University of Washington, Seattle, WA 98195
• Email:
  jeannes@uw.edu
• Federal Fiscal Year:
  2016
• Performing Organization:
  University of Washington, Seattle
• Peer Reviewed:
  False
• Start Date:
  20120901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20150831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:034c3543bcf1e36f2fdc29ba6e861e740fa76ff8e68e64d90c8b2f4f88e9ec6af5ff42d8c9ec8a13e1f2569b3c671203b015163de8a67f0a959e8ab07e1ac75f
• Download URL:
  https://stacks.cdc.gov/view/cdc/218770/cdc_218770_DS1.pdf
• File Type:
  [PDF - 627.10 KB ]