Sears Jeanne M, Bowman Stephen M, Rotert Mary, Hogg-Johnson Sheilah
Department of Health Services, School of Public Health, University of Washington, Box 357660, Seattle, WA, 98195, USA.
Institute for Work and Health, Toronto, ON, Canada.
J Occup Rehabil. 2015 Dec;25(4):742-51. doi: 10.1007/s10926-015-9582-5.
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.
WC claims for workers injured in Washington State from 1998 to 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 R(2).
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.
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.
急性工伤相关创伤是美国工人死亡和残疾的主要原因。现有的估计损伤严重程度的方法存在重要局限性。本研究评估了一个基于先前为监测目的制定的严重创伤性损伤诊断代码列表构建的严重损伤指标。研究目标是：（1）描述严重损伤指标预测工作残疾和医疗费用结果的程度；（2）评估该指标是否能充分替代根据工伤赔偿（WC）计费数据估计基于简明损伤定级（AIS）的损伤严重程度；（3）评估从华盛顿州创伤登记处（WTR）和WC数据构建的指标之间的一致性。
将1998年至2008年在华盛顿州受伤工人的WC索赔与WTR记录相关联。采用竞争风险生存分析对工作残疾结果进行建模。使用线性回归对调整后的总医疗费用进行建模。使用赤池信息准则和R²比较严重损伤指标和基于AIS的损伤严重程度测量的信息含量。
在208,522项符合条件的WC索赔中，5%被归类为严重。在与WTR相关联的WC索赔中，基于WC的指标和基于WTR的指标之间存在高度一致性（kappa = 0.75）。严重损伤指标的信息含量与一些基于AIS的测量相似。严重损伤指标是WTR纳入、早期住院、补偿性时间损失、完全永久性残疾和总医疗费用的重要预测指标。
当有诊断代码时，可以直接识别严重创伤性损伤。该方法为基于AIS的损伤严重程度估计提供了一种简单且透明的替代方法。
