Injury Surveillance Data Sources RAC Chairs Meeting August

Injury Surveillance Data Sources RAC Chairs Meeting August 19, 2010 Ryan Beal, MPH Texas Department of State Health Services

Objectives Ø To identify sites that provide injury research guidance including classification and coding standards Ø To introduce data sources that can be used in injury and trauma research Ø To describe how to access various data sources Ø To show examples

Injury Pyramid Deaths Hospitalizations Emergency Dept Primary Care/ Self Treat/ Never Treated

Resources for Injury Surveillance Guidance Ø Safe States Alliance (formerly STIPDA) l http: //www. safestates. org/ Ø Center for Disease Control and Prevention (CDC) l http: //www. cdc. gov/injury/wisqars/index. html Ø Inventory of National Injury Data Systems l http: //www. cdc. gov/Injury/wisqars/Inventory. Injury. Data. Sys. html

Data Sources Ø Death Data (Vital Records) Ø Fatality Analysis Reporting System (FARS) Ø Hospital Discharge Data Ø EMS/Trauma Registry Ø Youth Risk Behavior Surveillance System

Death Data Ø DSHS, Bureau of Vital Statistics Ø Deaths occurring in Texas and among Texas residents

Death Data: Strengths/Weaknesses Ø Strengths l l l Available years easily accessed Population-based Standardized/ Comparable Ø Weaknesses l l 2007 most recent data Limited number of trauma-related fields

Death Data: Access Ø Soupfin (Texas/ county) http: //soupfin. tdh. state. tx. us/deathdoc. htm Ø WISQARS (National/ state) http: //www. cdc. gov/injury/wisqars/index. html Ø Data file http: //www. dshs. state. tx. us/chs/vstat/

Accidents Intentional Self-Harm Assault

Suicide Across the Life-Span by Race/Ethnicity per 100, 000 White Black Hispanic Source: Texas Department of State Health Services, Vital Statistics Unit, 2003 -2006

Fatality Analysis Reporting System (FARS) ØNational Highway and Traffic Safety Administration (NHTSA) ØCrash involving a motor vehicle traveling on a trafficway customarily open to the public, and must result in the death of an occupant of a vehicle or a non-occupant within 30 days of the crash

FARS: Strengths/Weaknesses Ø Strengths l l Accessible Relatively recent Population-based Local data available Ø Weaknesses l Deaths only

Publications Data Tables Query Texas Data

Fatality Rates: Texas , U. S. and Best State (2008) Texas US Fatalities Total VMT (millions) Fatalities per 100 million VMT Total Population Fatalities Per 100, 000 Population 3, 382 235, 382 1. 44 24, 326, 974 13. 9 37, 261 2, 973, 509 1. 25 304, 059, 724 12. 25 Best State 0. 67 5. 59 * Vehicle Miles Traveled http: //www-nrd. nhtsa. dot. gov/departments/nrd-30/ncsa/STSI/48_TX/2008/48_TX_2008. htm

Hospital Discharge Data Ø DSHS, Texas Health Care Information Collection (THCIC) Ø Includes hospital discharges from all state licensed hospitals except those that are statutorily exempt

Hospital Discharge Data: Strengths/Weaknesses Ø Strengths l l l Ø Relatively recent Population-based Standardized, comparable Local data available Hospital charges Weaknesses l l l Restricted use Must be purchased Limited trauma data Incomplete E-code reporting Analytical skills needed

Hospital Discharge Data: Access Ø Public Use Data File http: //www. dshs. state. tx. us/thcic/ Ø State Injury Indicators Report

Hospital Charges by the Top 5 Causes of TBI Hospitalization, 2004 -2007 Avg. Std Dev Total Charges (millions) Cause of TBI Cases % of cases Falls 23, 085 45. 1% $35, 737 $51, 991 $825 32. 6% Motor vehicle traffic 19, 971 39. 0% $68, 601 $95, 734 $1, 370 54. 2% *Struck by/against 4, 778 9. 3% $32, 833 $57, 337 $156. 9 6. 2% **Other transportation 2, 299 4. 5% $44, 779 $69, 181 $102. 9 4. 1% Firearm 1, 020 2. 0% $71, 813 $102, 963 $73. 3 2. 9% 51, 153 100. 0% $49, 422 $76, 131 $2, 528 100. 0% Top 5 causes Percent of Charges * struck by/against includes: unarmed fight or brawl or using blunt object, legal intervention, struck and injured unintentionally by falling or stationary objects or persons, including TBI originating from sports. **Other transportation includes most instances of railway, bicycle, animal-drawn, watercraft, air/space, and non-traffic related injuries. THCIC Hospital Discharge Data, 2004 -2007

EMS/ Trauma Registry DSHS, Injury and EMS/Trauma Registry Group Ø 2 datasets Ø l l 1: EMS – EMS runs 2: Hospital – Trauma cases (ICD-9 -CM diagnosis codes 800 -959. 9 excluding 905 -909, 910 -924, and 930 -939 ) meeting any of the following: • • Admitted to a hospital for 48 hours or more Transferred into or out of the hospital Died after receiving any evaluation or treatment Dead on arrival

EMS/Trauma Registry Strengths/Weaknesses Ø Strengths l l l Ø Trauma specific data elements Recent data E-code reporting >98% Weaknesses l l Incomplete participation Limited access to data summaries Limited to trauma requiring admission for 48 hours or more Analytical skills needed

EMS/Trauma Registry: Access Ø Reports, data requests, PUDF l http: //www. dshs. state. tx. us/injury/ Ø TRACIT data submission site (txetra. com) l l EMS and Hospital reports Ad hoc data request

Reports

Outcome by EMS/RAC/State My EMS My RAC State 9 24 133, 577 16 21 48, 741 205 1, 762 255, 871 Treatment, No Transport 35 347 57, 238 Treatment, Transport Refused 32 68 108, 108 Transport and Treatment 1, 055 7, 537 1, 046, 398 Transport, No Treatment 15 372 85, 190 DNR, Transport 0 0 205 DNR, No Transport 0 0 1, 523 12 99 11, 622 5 396 340, 570 1, 384 10, 630 2, 089, 043 Call Cancelled False Alarm No Treatment, No Transport Dead on Scene Unknown Total

Cause of Injury by EMS/RAC/State My Hosp My RAC State Assault 988 2, 744 10, 842 Falls 837 6, 696 42, 248 10 437 2, 516 Motor vehicle 899 5, 183 28, 472 Other unintentional injury 402 2, 753 15, 817 Self-inflicted 98 286 1, 510 Undetermined intent injury 44 113 795 5 49 545 3, 283 18, 261 102, 745 Fires/burns Unspecified Total

Blood Alcohol Level Among Drivers Tested by Year Blood Alcohol Level (mg/dl) 2003 2004 2005 2006 2007 20032007 0 2, 757 3, 091 2, 970 3, 248 3, 528 15, 594 1 - 79 686 575 612 619 630 3, 122 >= 80 1, 831 1, 880 1, 844 1, 931 2, 084 9, 570 322 289 270 310 272 1, 463 95 38 458 417 341 1, 349 5, 691 5, 873 6, 154 6, 525 6, 855 31, 098 Percent >0 44. 2% 41. 8% 39. 9% 39. 1% 39. 6% 40. 8% Percent >= 80 32. 2% 32. 0% 30. 0% 29. 6% 30. 4% 30. 8% Unknown Missing/Invalid Total EMS/ Trauma Registry, 2003 -2007

Traffic Related EMS Runs by Day of Week and Time of Day, 2004 -2007 EMS/ Trauma Registry, 2004 -2007

Youth Risk Behavior Surveillance System (YRBSS) Ø DSHS, Center for Health Statistics Ø Classroom based paper survey monitoring priority health-risk behaviors that contribute substantially to the leading causes of death, disability, and social problems among youth

YRBSS: Strengths/Weaknesses Ø Strengths l l Ø Available years easily accessed Representative sample Standardized/ Comparable Injury focus Weaknesses: l l Limited local information Done every two years Survey data Self reported

YRBSS: Access Ø Query (Texas) http: //www. dshs. state. tx. us/chs/yrbs/ Ø Publications (national, state, major city) http: //www. cdc. gov/healthyyouth/yrbs/index. htm

Risk Factor: Percentage of students who rode one or more times during the past 30 days in a car or other vehicle driven by someone who had been drinking alcohol (2007) % Confidence Interval Texas 35. 6 32. 6 -38. 7 Median 27. 4 -- Best State 14. 8 12. 2 -17. 9 http: //www. cdc. gov/mmwr/PDF/ss/ss 5704. pdf

Other Data Sources Ø National EMS Information System (NEMSIS) l Ø National Trauma Data Bank (NTDB) l Ø https: //www. ntdbdatacenter. com/Default. aspx National Occupant Protection Use Survey (NOPUS) l Ø http: //www. nemsis. org/ http: //www-nrd. nhtsa. dot. gov/ Crash Records Information System (CRIS) l http: //www. dot. state. tx. us/drivers_vehicles/crash_records/form. htm

DSHS Injury Website Ø http: //www. dshs. state. tx. us/injury/ Ø Non-fatal Trauma Hospitalizations by TSA l Compare rates (TSA vs. Texas) Ø EMS/Trauma Registry Hospital Surveillance Reports by TSA Ø Fact Sheets l Falls, submersions, traumatic brain injury, suicide

Summary Ø Identified sites that provide injury research guidance including classification and coding standards Ø Introduced data sources that can be used in injury and trauma research Ø Described how to access Ø Showed examples

Contact Ryan Beal, MPH Epidemiologist Texas Department of State Health Services Injury and EMS/Trauma Registry Group 512. 458. 7111, ext. 2808 ryan. beal@dshs. state. tx. us