Injury Burden, Triage-Referral Practices and Hazard Identification: Work and Non-Work Related Injuries

Objectives: (1) Conduct and describe a step by step linguistic-based analysis of text fields in the National Burn Repository (NBR) in order to identify hazards/processes associated with severe burns across a broad range of occupations; (2) evaluate burn center referral practices and assess the differences in medical/economic outcomes among those treated in verified burn centers, non-verified burn centers, and facilities without specialized burn care teams; and (3) describe the level of care provided for all injuries in the U.S. between 2004-2016, with a focus on injuries treated exclusively outside of the hospital setting for all injuries, those that are work-related, and work-related injuries that occur among low-income workers. Methods: In Chapter 4, we extract and group text categories from the narrative injury event description in NBR using IBM SPSS Text Analytics and linking text categories that are significantly associated with severe burn injury to the constructs developed by factor analysis. In Chapter 5, we evaluated burn center referral practices, in addition to assessing the differences in medical outcomes among those treated in verified burn centers, non-verified burn centers and facilities without specialized burn care teams using current Illinois statewide inpatient and outpatient data. Chapter 6 characterizes the injury pyramid by describing the level of care provided for all injuries in the U.S. between 2004-2016 using National Health Interview Surveys. Results: (1) Our study suggested that “explosion/electricity line/pump” among construction/extraction occupations, “fire/torch/shirt” among production occupations, “mechanical device/explosion/controller/outlet” and “fire/clothes” among installation/repair/maintenance occupations, and “driver/vehicle/gas/fire” among transportation/material moving occupations are associated with higher median percent Total Body Surface Area (TBSA), as well as higher odds of suffering TBSA over 10% and full-thickness burns. (2) In our study an estimated 66% of inpatients who were treated exclusively in facilities without specialized burn care met the ABA criteria for referral to a burn center. Proximity to burn centers as well as the severity of burn injury remain important drivers for referral to burn units. Burned patients originally treated in level 1 trauma centers that do not have burn units are less likely to be transferred to a burn center (OR: 4.1, 95% CI: 3.5, 4.8). In the assessment of specialized burn centers’ association with better outcomes compared to patients in facilities without specialized burn care, patients treated in verified and non-verified burn centers were less likely to have reported infection complications during their hospital stay (OR: 0.5, 95% CI: 0.4, 0.6) and were less likely to be discharged to a skilled nursing/rehabilitation facility (OR: 0.5, 95% CI: 0.4, 0.6). (3) Our study showed that 53.1% of work-related injury were exclusively treated outside of a hospital setting and never captured by hospital/emergency department (ED) data systems. The cumulative total missed days of work among those treated exclusively outside hospitals comprises 41.2% of total missed days of work. Patients with work-related injuries are less likely to stay overnight in hospital compared to those with non-work-related injuries (OR:0.6, 95% CI: 0.5, 0.7), but among work-related injuries, low income patients are more likely to receive medical care in a hospital setting compared to patients with income higher than poverty threshold (Hospitalization: OR 1.9, 95% CI: 1.1, 3.3, Emergency room: OR: 1.5, 95% CI: 1.1, 2.0). Conclusions: The analysis shows that the NBR narrative text is valuable in identifying occupational burn injury hazards/process through combining linguistic text analytics, statistic modeling and factor analysis. The ABA referral criteria appear to be implemented in triage of burn victims requiring hospitalization, but there are still a large proportion of patients treated entirely in non-burn centers who meet the ABA burn center referral criteria. Verified and unverified burn centers demonstrate better functional outcomes from observation data compared to non-burn center counterparts among patients who meet ABA burn center referral criteria. The “minor injuries” exclusively treated outside hospital tend to be ignored when defining national injury prevention priorities, but our analysis indicates that such an approach fails to capture a large portion of injuries significant enough to result in missed days of work.