Using injury severity to improve occupational injury trend estimates

Am J Ind Med. 2014 Aug;57(8):928-39. doi: 10.1002/ajim.22329. Epub 2014 May 8.


Background: Hospitalization-based estimates of trends in injury incidence are also affected by trends in health care practices and payer coverage that may differentially impact minor injuries. This study assessed whether implementing a severity threshold would improve occupational injury surveillance.

Methods: Hospital discharge data from four states and a national survey were used to identify traumatic injuries (1998-2009). Negative binomial regression was used to model injury trends with/without severity restriction, and to test trend divergence by severity.

Results: Trend estimates were generally biased downward in the absence of severity restriction, more so for occupational than non-occupational injuries. Restriction to severe injuries provided a markedly different overall picture of trends.

Conclusions: 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.

Keywords: abbreviated injury scale; hospital discharge data; injury severity; injury surveillance; injury trends; occupational health indicator; occupational injuries; workers' compensation.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Accidents, Occupational / trends*
  • Bias
  • Health Care Surveys
  • Hospitalization / trends
  • Humans
  • Incidence
  • Occupational Injuries / epidemiology*
  • Occupational Injuries / etiology
  • Population Surveillance*
  • Trauma Severity Indices*
  • United States / epidemiology
  • Workers' Compensation / trends