texas state health services crash/ems/hospital trauma data linkage
TRANSCRIPT
Linking Crash Data with EMS Reports and
Hospital Records
Christopher Drucker, PhD Injury Epidemiology & Surveillance Branch
Environmental and Injury Epidemiology and Toxicology Unit Environmental Epidemiology and Disease Registries Section
Project Funding Support
Traffic Safety Grant 2015-TDSHS-IS-G-1YG-0157
2
• To link crash data with statutorily reportable injury and event data • Crash – Crash Reporting Information System (TxDOT) • EMS – EMS & Trauma Registries (DSHS) • Hospitalizations – EMS & Trauma Registries (DSHS)
• To assess injury characteristics for motorcyclists
involved in crashes
3
Project Objective
• Motor vehicle crashes are a persistent public health burden which causes nonfatal and fatal injuries
4
Background
PH Burden
5
Why is linking these data important?
• Puzzling Question – types of responses and injuries sustained in motor vehicle crashes
Cont inuum of Care
6
Why is linking these data important?
• We get a completed puzzle
7
Linking Process • Link Plus v2.0 (CDC) • Probabilistic linkage
– Date of Birth – Sex – Injury Date – SSN – Injury County Code – Last Name – First Name – Middle Name – Injury/ Dispatch Time
• Implemented a “high” cut-off value – Trade-off between FP (non-matches) and FN
(matches)
8
Puzzle Links Completed, 2013
EMS Runs Observations Percent
Total 2,598,444 100
MV-related* 83,279 3.2
Non-Transfer 72,199 86.7†
Linked 38,106 52.8‡
* Based on reported cause of injury: E-codes 810-819, 820-825 † Percent of Non-Transfer to MV-related ‡ Percent of linked records to Non-Transfer records
9
Hospitalizations Observations Percent
Total 129,778 100
Initial POC 99,143 76.4
MV-related* 27,073 27.3†
Linked 12,078 44.6‡
* Based on reported cause of injury: E-codes 810-819, 820-825 † Percent of MV-related to Initial Point of Care ‡ Percent of linked records to MV-related records
Puzzle Links Completed, 2013
10
Puzzle Links Completed, 2013
Master Link Observations Percent
Crash to EMS 38,106 100
Crash to EMS to Hospital
4,321 11.3
11
Injuries Sustained to Motorcyclists, 2013
Age Group (among Incapacitating Injury)
Helmet Worn (%)*
Helmet Not Worn (%)*
0 – 14 1 (25.0) 3 (75.0)
15 – 34 348 (56.6) 267 (43.4)
35 –54 266 (41.0) 382 (59.0)
55 – 74 150 (53.6) 130 (46.4)
75 & over 7 (70.0) 3 (30.0)
Total 772 (49.6) 785 (50.4)
1,557 motorcycle drivers sustained an incapacitating injury according to CRIS, 2013
Source: Motorcyclist Fatalities and Injuries by Age Group and Helmet Use, TxDOT, 2013
* Row percent
12
Injuries Sustained to Motorcyclists, 2013
Age Group (among Incapacitating Injury)
Helmet Worn (%)*
Helmet Not Worn (%)*
0 – 14 1 (100) 0 (0)
15 – 34 75 (21.6) 65 (24.3)
35 –54 76 (28.6) 99 (25.9)
55 – 74 42 (28.0) 31 (23.8)
75 & over 2 (28.6) 0 (0)
Total 196 (25.4) 195 (24.8)
391 motorcycle drivers sustained an incapacitating injury with linked EMS and hospital records, 2013
* Percent of CRIS data captured in linked dataset
13
Types of Injuries Sustained to Motorcyclists (Crash Inj. Cat = A),
35 – 54 years of age, 2013
Injury Diagnoses* Helmet Worn (%)†
Helmet Not Worn
(%)†
Total
Superficial Injury 70 (49.3) 72 (50.7) 142
Fx of Spine and Trunk 69 (52.3) 63 (47.7) 132
Fx of Lower Limb 59 (47.2) 66 (52.8) 125
Fx of Skull 21 (18.9) 90 (81.1) 111
Fx of Upper Limb 60 (56.1) 47 (43.9) 107
Open Wound to Head, Neck and Trunk 11 (17.5) 52 (82.5) 63
Incapacitating Injury, 35 through 54 years of age, 2013 (n = 175)
* Not mutual exclusive, based on ICD-9-CM codes; † Row percent; Fx = Fracture
14
Types of Injuries Sustained to Motorcyclists (Crash Inj. Cat = A),
35 – 54 years of age, 2013
Injury Diagnoses* Helmet Worn (%)†
Helmet Not Worn
(%)†
Total
Superficial Injury 70 (49.3) 72 (50.7) 142
Fx of Spine and Trunk 69 (52.3) 63 (47.7) 132
Fx of Lower Limb 59 (47.2) 66 (52.8) 125
Fx of Skull 21 (18.9) 90 (81.1) 111
Fx of Upper Limb 60 (56.1) 47 (43.9) 107
Open Wound to Head, Neck and Trunk 11 (17.5) 52 (82.5) 63
Incapacitating Injury, 35 through 54 years of age, 2013 (n = 175)
* Not mutual exclusive, based on ICD-9-CM codes; † Row percent; Fx = Fracture
15
Fx. of Skull Injuries Sustained to Motorcyclists (Crash Inj. Cat = A),
35 – 54 years of age, 2013, n = 111 Injury Diagnoses* Helmet
Worn (%)† Helmet
Not Worn (%)† Total
Closed Fx of Base of Skull w/ subarachnoid ,subdural and extradural hemorrhage
18 (27.3) 48 (72.7) 66
Closed Fx of vault of Skull w/ subarachnoid ,subdural and extradural hemorrhage, with prolonged (>24hrs) LOC, w/o return to pre-existing conscious level
0 (0.0) 51 (100) 51
Closed Fx of base of Skull w/ subarachnoid ,subdural and extradural hemorrhage, with prolonged (>24hrs) LOC, w/o return to pre-existing conscious level
1 (2.4) 40 (97.6) 41
* Not mutual exclusive, based on ICD-9-CM codes; † Row percent; Fx = Fracture
16
Conclusion
• Linked data enables – Increase specificity of injuries – New dimensions for assessing
outcome data – Impact of EMS response and patient
field care – New public health strategies with
policy implication
17
Thank You
Christopher Drucker, PhD Injury Epidemiology & Surveillance Branch Environmental & Injury Epidemiology & Toxicology Unit Environmental Epidemiology & Disease Registries Section [email protected] (Data Requests) [email protected] (My Info)