Using injury severity to improve occupational injury trend estimates

Abstract

Severity restriction may improve occupational injury trend estimates by reducing temporal biases such as increasingly restrictive hospital admission practices, constricting workers' compensation coverage, and decreasing identification/reporting of minor work-related injuries. Injury severity measures should be developed for occupational injury surveillance systems.

Improving occupational injury surveillance by using a severity threshold: development of a new occupational health indicator

“…This study confirms and extends findings from a previous paper that reported similar analyses in fewer states, using an AIS-based threshold rather than this newly developed list 21. Trend estimates were generally biased downwards in the absence of severity restriction, more so for occupational than non-occupational injuries (table 2).…”

“…There may be a contributory survival shift effect (ie, targeted fatality prevention efforts preventing death but not severe injury or severe injury less often proving fatal due to trauma system improvements). These potential collective or alternative mechanisms have been discussed at more length in previous related publications 21 37 38…”

“…The National Center for Health Statistics17 and a growing body of research suggest that severity restriction may be an important approach to mitigate the impact of changing healthcare delivery and utilisation patterns on observed injury trends 15 16 18–21. In a previous study using the National Hospital Discharge Survey (NHDS) and hospital discharge data from four states, we found evidence that observed injury trends were biased downwards in the absence of severity restriction 21. Inadequate severity measurement coupled with increasingly incomplete ascertainment of minor injuries may be contributing to an unwarranted optimism about work-related injury trends 4 5 19–21…”

“…Methods used for this study were similar to those described in a previous publication21 with two important updates: (1) the newly developed severe injury definition was used in place of the previous AIS-based severity threshold and (2) the number of included states was expanded from four to nine.…”

Disparities in occupational injury hospitalization rates in five states (2003–2009)

“…This type of severity score provides a reliable estimate of initial injury severity, independent of patient‐specific factors that may influence hospitalization. In particular, AIS provides more face validity and empirical support as a measure of initial injury severity than do hospital admission or length of stay, both of which can be related to co‐existing conditions, health status, and trends in insurance coverage and standards of care [National Center for Health Statistics (NCHS) Expert Group on Injury Severity Measurement, ; Stephenson et al, ; Cryer and Langley, ; Cryer et al, ; Sears et al, ]. AIS‐based injury severity scores have been validated for prediction of mortality [Baker et al, ; Osler et al, ; Meredith et al, ; Kilgo et al, ; Harwood et al, ], and recent studies have established their association with occupational injury outcomes such as work disability and medical costs [Ruestow and Friedman, ; Sears et al, ].…”