Currently, severity of injuries is estimated by police on the scene of a traffic crash. A very simple rating scale is employed by many states or communities, i.e., the KABCO injury scale or a comparable version. Basically, the police officer codes the overall level of injury each person receives as killed, incapacitating, non-incapacitating, possible, or no injury. Each of these levels has a definition and criteria for rating. However, what the officer observes at a crash scene can differ substantially from what is found by medical personnel. The National Highway Traffic Safety Administration (NHTSA) facilitates the Crash Outcome Data Evaluation System (CODES). State CODES programs conduct a probabilistic matching of statewide health records with crash reports. However, a limited number of states are participating in this system, and the technical process is complex. Trying to connect police reports with any further medical outcome or cost data can be technically difficult. Also, organizational and other barriers may exist for making such linkages within states. Performance measures are extensively referenced in draft proposals for the surface transportation reauthorization bill. For the measurement of safety performance, both fatal and non-fatal serious injuries are emphasized in these proposals. NHTSA and the Governors Highway Safety Association recently developed a series of safety performance measures that include use of fatalities and serious non-fatal injuries. The American Association of State Highway and Transportation Officials has also been working to develop similar performance measures. If serious non-fatal injuries and crashes are to become major performance measures for states, then an accurate and feasible method for determining level-of-injury severity based on a medical assessment is needed.
The objectives of this research are to:
(a) Identify an injury scoring system for further consideration. Analyze the advantages and disadvantages of conventional injury scoring systems based on International Statistical Classification of Diseases and Related Health Problems (ICD) codes and KABCO. Document advantages and disadvantages of various definitions for a serious injury metric. (b) Develop a roadmap to assist states in developing and implementing an interim system to measure and report injury severity using accepted injury scoring systems based on ICD codes. The intent of the roadmap is to enable year-to-year performance assessment by states using a standard measure. At a minimum, the roadmap should document a workable process(es) for linking statewide crash and hospital discharge data. For states where complete crash and/or hospital discharge data do not exist, identify surrogate sources, such as trauma registries, or alternative measures, such as estimates, that can be used within the workable process as an interim step until the preferred process(es) can be implemented. Identify means to overcome technical, legal, political, financial, and other challenges to implementation and linkage of these state-based data systems. The states’ future performance assessments will yield at a minimum the number of serious injury crashes and the number of persons seriously injured in each state using a standardized definition. This step should lead to the ultimate outcome, which is a unified database as described further in (c). (c) Expanding on (b), develop a state-based framework to perform comprehensive linkage of records related to motor vehicle crashes resulting in serious injuries, and incremental steps and priorities for achieving the linkage. A direct linkage is strongly preferred but it is recognized that alternative linkage methods may be appropriate, so the framework should include methods to be used when linkage is unsuccessful. Records may include crash and citation records; pre-hospital (telematics, 911, EMS, etc.); hospital (ED/inpatient); disability; death (coroner, medical examiner, vital statistics); trauma registries; traumatic brain injury registries; and roadway and traffic inventories. The framework will provide for a comprehensive analysis and understanding of the factors associated with serious injuries before, during, and after the crashes, and the associated medical outcomes. This will allow for the development, implementation, and evaluation of countermeasures for serious injury crashes, and continuous system improvement.
STATUS: Completed - Agency report available as an NCHRP web-only document. It can be downloaded here.