A New Method to Classify Injury Severity by Diagnosis: Validation Using Workers' Compensation and Trauma Registry Data.
A New Method to Classify Injury Severity by Diagnosis: Validation Using Workers' Compensation and Trauma Registry Data.
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一种通过诊断对伤害严重程度进行分类的新方法：使用工人补偿和创伤注册表数据进行验证。
DOI：
10.1007/s10926-015-9582-5
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发表时间：
2015-12
影响因子：
3.3
通讯作者：
Hogg-Johnson S
中科院分区：
文献类型：
--
作者：
Sears JM;Bowman SM;Rotert M;Hogg-Johnson S
与工作有关的急性创伤是美国工人死亡和残疾的主要原因。现有的估计损伤严重程度的方法具有重要的局限性。本研究评估了一个严重损伤指标，该指标是根据以前为监测目的开发的严重创伤诊断代码列表构建的。研究目的是：（1）描述严重伤害指标预测工作残疾和医疗费用结果的程度;（2）评估该指标是否足以替代根据工人赔偿（WC）账单数据估计基于简明伤害量表（AIS）的伤害严重程度;（3）评估根据华盛顿州创伤登记处（WTR）和WC数据构建的指标之间的一致性。1998-2008年华盛顿州工人受伤的WC索赔与WTR记录有关。竞争风险生存分析被用来模拟工作残疾的结果。调整后的总医疗费用采用线性回归建模。使用赤池信息标准和R2比较了严重伤害指标和基于AIS的伤害严重程度测量的信息内容。在208，522例符合条件的WC索赔中，5%被归类为重度。在与WTR相关的WC索赔中，基于WC的指标和基于WT的指标之间存在实质性的一致性（kappa=0.75）。严重伤害指标的信息内容类似于一些基于AIS的措施。严重损伤指标是WTR纳入、早期住院、补偿时间损失、总永久残疾和总医疗费用的重要预测因素。当诊断代码可用时，可以直接识别严重的创伤性损伤。该方法为基于AIS的损伤严重度估计提供了一种简单而透明的替代方案。
Acute work-related trauma is a leading cause of death and disability among U.S. workers. Existing methods to estimate injury severity have important limitations. This study assessed a severe injury indicator constructed from a list of severe traumatic injury diagnosis codes previously developed for surveillance purposes. Study objectives were to: (1) describe the degree to which the severe injury indicator predicts work disability and medical cost outcomes; (2) assess whether this indicator adequately substitutes for estimating Abbreviated Injury Scale (AIS)-based injury severity from workers' compensation (WC) billing data; and (3) assess concordance between indicators constructed from Washington State Trauma Registry (WTR) and WC data. WC claims for workers injured in Washington State from 1998-2008 were linked to WTR records. Competing risks survival analysis was used to model work disability outcomes. Adjusted total medical costs were modeled using linear regression. Information content of the severe injury indicator and AIS-based injury severity measures were compared using Akaike Information Criterion and R2. Of 208,522 eligible WC claims, 5% were classified as severe. Among WC claims linked to the WTR, there was substantial agreement between WC-based and WTR-based indicators (kappa=0.75). Information content of the severe injury indicator was similar to some AIS-based measures. The severe injury indicator was a significant predictor of WTR inclusion, early hospitalization, compensated time loss, total permanent disability, and total medical costs. Severe traumatic injuries can be directly identified when diagnosis codes are available. This method provides a simple and transparent alternative to AIS-based injury severity estimation.