Using Injury Severity to Improve Occupational Traumatic Injury Trend Estimates

描述（由申请人提供）：创伤登记已在几个州用于职业伤害监测和研究。与医院出院数据相比，创伤登记有几个优势，包括有关损伤和初始治疗的详细信息，并且通常是一个特定的工作领域，可以独立于付款人识别工伤。使用华盛顿州创伤登记处（WTR）发现，2003-2008年，年龄调整后的中度/重度工伤报告率呈显著上升趋势，而当轻度工伤报告也包括在内时，则呈平缓趋势。拉丁裔的上升趋势尤其明显。国家卫生统计中心伤害严重程度测量专家组指出，“受伤住院出院和急诊就诊的趋势至少代表了两种影响的混合：1)伤害发生率的趋势2)服务利用和服务提供的趋势。因为两者都会随着时间的推移而变化……伤害发生率可以通过不受使用和服务提供等外部因素影响的伤害指标（例如达到严重阈值的伤害）来更好地反映。”随着时间的推移，不充分的严重程度特征加上越来越不完整的轻微工伤报告或捕获可能导致对工伤率总体趋势的毫无根据的乐观。具体目标1：制定并提交一个新的职业健康监测指标，该指标可以基于大多数州的创伤登记或医院出院数据（与工作有关的创伤住院），并提交给NIOSH-CSTE职业健康监测工作组。利用国家医院出院调查和来自4个州（AZ， FL， NJ， WA）的出院记录，评估：(1)通过应用严重程度限制来确定与所有住院工作相关的非致命创伤伤害的稳定子集是否会导致不同的趋势估计，(2)趋势是否因种族/民族而异，以及(3)特定的伤害类型或原因是否可能驱动趋势。具体目标2：评估具有强制性报告要求的州创伤登记处是否可以作为基于人群的数据库的合理近似，用于与工作有关的非致命严重创伤监测。特别是，评估华盛顿州医院的出院数据是否证实了向WTR报告的与工作有关的严重创伤的上升趋势，以及拉丁美洲人的上升率和趋势。将此信息与有关WTR纳入标准变化和报告医院变化的信息结合使用，评估WTR随时间推移的相对代表性。具体目标3：将WTR和华盛顿州医院出院数据联系起来，以评估数据领域的一致性，特别是与职业卫生服务研究相关的数据领域，包括付款人、种族/民族和ICD-9-CM外因伤害代码（电子代码）。使用关联数据评估基于e码的方法，以确定出院记录中的工伤情况。

DESCRIPTION (provided by applicant): Trauma registries have been used in several states for occupational injury surveillance and research. Trauma registries have several advantages over hospital discharge data, including details about the injury and initial treatment and often a specific work-related field that allows identification of work-related injuries independent of paye. Significant upward trends (2003-2008) in age-adjusted rates of moderate/major work-related traumatic injury reports were found using the Washington State Trauma Registry (WTR), in contrast to flat trends when minor work-related traumatic injury reports were also included. Upward trends were particularly steep for Latinos. The National Center for Health Statistics Expert Group on Injury Severity Measurement stated, "Trends in injury hospitalization discharges and emergency department visits represent a mixture of at least two effects: 1) trends in the incidence of injury 2) trends in service utilization and service delivery. Because both can vary over time...the incidence of injury would be better reflected by an indicator of the injury (e.g. injuries meeting a severity threshold) that is 'free' of extraneous factors like utiliation and service delivery." Inadequate severity characterization coupled with increasingly incomplete reporting or capture of minor work- related injuries over time may be contributing to an unwarranted optimism about overall trends in work-related injury rates. Specific Aim 1: Develop and submit a new occupational health surveillance indicator that can be based on trauma registry or hospital discharge data available in most states (Work-Related Traumatic Injury Hospitalizations) to the NIOSH-CSTE Occupational Health Surveillance Work Group. Using the National Hospital Discharge Survey and hospital discharge records from 4 states (AZ, FL, NJ, WA), assess: (1) whether identifying a stable subset of severe work-related nonfatal traumatic injuries by applying a severity restriction results in different trend estimates than those based o all hospitalized work-related nonfatal traumatic injuries, (2) whether trends diverge by race/ethnicity, and (3) whether particular injury types or causes may be driving trends. Specific Aim 2: Assess whether a state trauma registry with mandatory reporting requirements can serve as a reasonable approximation to a population-based database for the purposes of work-related nonfatal severe traumatic injury surveillance. In particular, assess whether Washington State hospital discharge data validate the upward trends in work-related severe traumatic injuries reported to the WTR, as well as the increased rates and trends among Latinos. Use this information in conjunction with information on changes in WTR inclusion criteria and changes in reporting hospitals to assess the relative representativeness of the WTR over time. Specific Aim 3: Link WTR and Washington State hospital discharge data to assess concordance for data fields, particularly relevant to occupational health services research, including payer, race/ethnicity, and ICD-9-CM external cause of injury codes (E-codes). Use the linked data to evaluate E-code based methods of identifying work-related injuries in hospital discharge records.