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Predicting Work-Related Disability and Medical Cost Outcomes: Estimating Injury Severity Scores from Workers’ Compensation Data

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Abstract

Purpose Acute work-related trauma is a leading cause of death and disability among US workers. The research objectives were to assess: (1) the feasibility of estimating Abbreviated Injury Scale-based injury severity scores (ISS) from ICD-9-CM codes available in workers’ compensation (WC) medical billing data, (2) whether ISS predicts work-related disability and medical cost outcomes, (3) whether ISS adds value over other injury severity proxies, and (4) whether the utility of ISS differs for an all-injury sample compared with three specific injury samples (amputations, extremity fractures, traumatic brain injury). Methods ISS was estimated from ICD-9-CM codes using Stata’s user-written -icdpic- program for 208,522 compensable nonfatal WC claims for workers injured in Washington State from 1998 to 2008. The Akaike Information Criterion and R2 were used to compare severity measures. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modeled using linear regression. Results Work disability and medical costs increased monotonically with injury severity. For a subset of 4,301 claims linked to the Washington State Trauma Registry (WTR), there was moderate agreement between WC-based ISS and WTR-based ISS. Including ISS together with an early hospitalization indicator resulted in the most informative models; however, early hospitalization is a more downstream measure. Conclusions ISS was significantly associated with work disability and medical cost outcomes for work-related injuries. Injury severity should be considered as a potential confounder for occupational injury intervention, program evaluation, or outcome studies, and can be estimated using existing software when ICD-9-CM codes are available.

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Acknowledgments

This study was funded by the National Institute for Occupational Safety and Health (NIOSH), grant 1R03OH009883. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH. Authors Sears, Blanar, Bowman, Adams, and Silverstein have no commercial interest related to this research. We gratefully acknowledge Kathy Schmitt, Zeynep Shorter, Mary Rotert, and Susan Reynolds at the Washington State Department of Health Trauma Registry for providing the data and for their extensive and generous explanations of many aspects of the trauma care system and the underlying data generating processes. We also thank Anthony R. Carlini at Johns Hopkins University for his helpful explanations and technical assistance with the ICDMAP-90 software, and Kevin Campbell, developer of The Link King software, for his gracious technical assistance.

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Authors and Affiliations

  1. Department of Health Services, School of Public Health, University of Washington, Box 354809, Seattle, WA, USA

    Jeanne M. Sears & Laura Blanar

  2. Department of Health Policy and Management, Bloomberg School of Public Health, Center for Injury Research and Policy, Johns Hopkins University, Baltimore, MD, USA

    Stephen M. Bowman

  3. Safety and Health Assessment and Research for Prevention (SHARP), Washington State Department of Labor and Industries, Safety, Olympia, WA, USA

    Darrin Adams & Barbara A. Silverstein

  4. Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA

    Barbara A. Silverstein

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  1. Jeanne M. Sears
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Correspondence to Jeanne M. Sears.

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Sears, J.M., Blanar, L., Bowman, S.M. et al. Predicting Work-Related Disability and Medical Cost Outcomes: Estimating Injury Severity Scores from Workers’ Compensation Data. J Occup Rehabil 23, 19–31 (2013). https://doi.org/10.1007/s10926-012-9377-x

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