• injury severity;
  • abbreviated injury scale;
  • injury trends;
  • injury surveillance;
  • occupational injuries;
  • hospital discharge data;
  • workers' compensation;
  • occupational health indicator


Hospitalization-based estimates of trends in injury incidence are also affected by trends in health care practices and payer coverage that may differentially impact minor injuries. This study assessed whether implementing a severity threshold would improve occupational injury surveillance.


Hospital discharge data from four states and a national survey were used to identify traumatic injuries (1998–2009). Negative binomial regression was used to model injury trends with/without severity restriction, and to test trend divergence by severity.


Trend estimates were generally biased downward in the absence of severity restriction, more so for occupational than non-occupational injuries. Restriction to severe injuries provided a markedly different overall picture of trends.


Severity restriction may improve occupational injury trend estimates by reducing temporal biases such as increasingly restrictive hospital admission practices, constricting workers' compensation coverage, and decreasing identification/reporting of minor work-related injuries. Injury severity measures should be developed for occupational injury surveillance systems. Am. J. Ind. Med. 57:928–939, 2014. © 2014 Wiley Periodicals, Inc.