title: Using injury severity to improve occupational injury trend estimates.
abstract: 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.
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Sears
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Bowman
authors.forename: Sheilah
authors.initials: S
authors.lastname: Hogg-Johnson
mesh_terms: D000062:Accidents, Occupational / Q000639:trends*; D015982:Bias; D019538:Health Care Surveys; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D060051:Occupational Injuries / Q000453:epidemiology* / Q000209:etiology; D011159:Population Surveillance; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014942:Workers' Compensation / Q000639:trends
keywords: abbreviated injury scale; hospital discharge data; injury severity; injury surveillance; injury trends; occupational health indicator; occupational injuries; workers' compensation