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。创伤登记与医院出院数据相比有几个优势，包括关于伤害和初步治疗的详细信息，并且通常是一个特定的与工作相关的领域，允许独立于工资识别与工作相关的伤害。华盛顿州创伤登记处(WTR)发现，中度/主要工伤报告的年龄调整率(2003-2008年)有显著上升趋势，而如果将轻微工伤报告也包括在内，趋势则持平。拉丁裔的上升趋势尤其陡峭。美国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科就诊的趋势代表了至少两种影响的组合：1)伤害发生率的趋势；2)服务利用和服务提供的趋势。因为两者都可能随着时间的推移而变化……伤害的发生率将更好地反映伤害指标(例如，达到严重程度阈值的伤害)，该指标‘不受’使用和服务提供等外部因素的影响。”严重程度描述不充分，加上随着时间推移对轻微工伤的报告或记录越来越不完整，可能会导致对工伤发生率的总体趋势产生不必要的乐观。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，该指标可基于大多数州(工伤住院)的创伤登记或出院数据。使用全国医院出院调查和4个州(亚利桑那州、佛罗里达州、新泽西州、华盛顿州)的出院记录，评估：(1)通过应用严重程度限制来确定严重工伤的稳定子集是否会导致与所有住院的工伤不同的趋势估计，(2)趋势是否因种族/民族而异，以及(3)特定伤害类型或原因是否可能是驱动趋势。具体目标2：评估具有强制性报告要求的国家创伤登记是否可以作为基于人口的数据库的合理近似值，用于与工作相关的非致命性严重创伤监测。特别是，评估华盛顿州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伤害的上升趋势，以及拉美裔比例和趋势的增加。将这些信息与关于WTR纳入标准的变化和报告医院的变化的信息结合使用，以评估WTR随着时间的推移的相对代表性。具体目标3：将WTR和华盛顿州医院出院数据联系起来，以评估数据字段的一致性，特别是与职业卫生服务研究相关的数据，包括支付者、种族/民族和ICD-9-CM伤害外部原因代码(E代码)。使用关联数据来评估基于E代码的在医院出院记录中识别工伤的方法。 公共卫生相关性：急性工伤是美国工人死亡和残疾的主要原因，对工人补偿系统和整个社会来说代价非常高昂。准确描述伤害趋势对于了解我们国家在职业伤害预防方面做得如何至关重要。这项研究将探讨更准确地估计严重创伤伤害趋势的方法，并将为职业健康研究人员和政策制定者提供直接有助于伤害监测和确定预防机会的信息。

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. PUBLIC HEALTH RELEVANCE: Acute work-related trauma is a leading cause of death and disability among U.S. workers, and is very costly for workers' compensation systems and society as a whole. Accurate characterization of injury trends is critical to understanding how we are doing as a nation with regard to occupational injury prevention. This study will investigate methods to produce more accurate estimates of trends in severe traumatic injuries and will provide occupational health researchers and policy-makers with information directly useful for injury surveillance and identification of prevention opportunities.