A New Method to Classify Injury Severity by Diagnosis: Validation Using Workers’ Compensation and Trauma Registry Data

Abstract

Purpose 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. Methods 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. Results 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. Conclusions 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.

Population‐Based Signals of Antidepressant Drug Interactions Associated With Unintentional Traumatic Injury

“…Consistent with the American College of Surgeons' National Trauma Data Standard, this excluded: late effects of injuries, poisonings, toxic effects, and other external causes, superficial injuries, contusions with intact skin surface, and effects of a foreign body entering through an orifice. Consistent with work by Sears et al, 42 we also excluded burns; such injuries seem unlikely due to antidepressant use.…”

An analysis of fatal and non‐fatal injuries and injury severity factors among electric power industry workers

“…The nature of injury is a qualitative indicator of injury severity (e.g., a fracture is generally a more severe injury than a cut or laceration); however, some nature of injury categories might encompass both minor and severe injuries (e.g., burns), limiting the usefulness of this measure. Medically based injury and illness severity classifications (e.g., Abbreviated Injury Scale, Injury Severity Score) are not available in the EPRI OHSD, but have been found to be useful for a limited group of traumatic injuries [Sears et al, ] and other qualitative proxy variables for severity such as costs could not be used because the definition of total costs varied across companies. Classification of injuries in non‐specific injury type classifications may underestimate the severity of certain injury types.…”

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

“…In a related validation study, we linked Washington State Trauma Registry (WTR) records with WC claims for injuries from 1998 through 2008 (N=208 522) and found that traumatic injuries classified as severe using the severe injury list (table 1) were significantly more likely than those classified as minor/indeterminate to (1) be reported to the WTR, (2) involve an early hospitalisation, (3) result in total permanent disability or death, (4) have more compensated lost work days, (5) have higher total medical costs and (6) have an unresolved claim after long-term follow-up 27. There was substantial injury severity classification agreement between WTR clinical diagnoses and WC billing diagnoses (kappa=0.75), suggesting that diagnostic information contained in billing data is adequate for this purpose 27…”