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。与出院数据相比，创伤登记有几个优势，包括关于伤害和初始治疗的细节，通常是一个特定的与工作有关的领域，可以独立于paye识别与工作有关的伤害。使用华盛顿州创伤登记处（WTR）发现，经年龄调整的中度/重大工伤创伤报告率呈显著上升趋势（2003-2008年），而将轻度工伤创伤报告也纳入时，则呈平稳趋势。拉丁美洲人的上升趋势尤其陡峭。国家卫生统计中心伤害严重程度测量专家组指出，“伤害住院出院和急诊室就诊的趋势代表了至少两种影响的混合：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而变化...一个不受使用率和服务提供等外在因素影响的受伤指标（例如符合严重程度的受伤个案），会更能反映受伤个案的发生率。“严重程度描述不足，加上随着时间的推移，轻微工伤的报告或记录越来越不完整，可能导致对工伤率总体趋势的不必要的乐观。具体目标1：制定并向NIOSH-CSTE职业健康监测工作组提交一项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出院数据（与工作有关的创伤住院）。使用全国出院调查和来自4个州的出院记录（亚利桑那州、佛罗里达州、新泽西州、华盛顿州），评估：（1）通过应用严重度限制来识别严重工作相关非致命性创伤性损伤的稳定子集是否导致与基于所有住院工作相关非致命性创伤性损伤的趋势估计不同的趋势估计，（2）趋势是否因种族/民族而不同，以及（3）特定伤害类型或原因是否可能是驾驶趋势。具体目标二：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口的数据库的合理近似，用于与工作相关的非致命性严重创伤性损伤监测。特别是，评估华盛顿州立医院出院数据是否证实了向WTR报告的与工作有关的严重创伤性伤害的上升趋势，以及拉丁美洲人的比率和趋势的增加。将这些信息与WTR纳入标准的变化和报告医院的变化相结合，以评估WTR随时间的相对代表性。具体目标3：链接WTR和华盛顿州立医院出院数据，以评估数据字段的一致性，特别是与职业健康服务研究相关的数据字段，包括付款人、种族/民族和ICD-9-CM外部伤害原因代码（E代码）。使用链接的数据来评估基于电子代码的方法来识别医院出院记录中的工伤。

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.