Evaluating the Use of Existing Data Sources, Probabilistic Linkage, and Multiple Imputation to Build Population-based Injury Databases Across Phases of Trauma Care

Authors

  • Craig Newgard MD, MPH,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • Susan Malveau MSBME,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • Kristan Staudenmayer MD,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • N. Ewen Wang MD,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • Renee Y. Hsia MD, MSc,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • N. Clay Mann MS, PhD,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • James F. Holmes MD, MPH,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • Nathan Kuppermann MD, MPH,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • Jason S. Haukoos MD, MSc,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • Eileen M. Bulger MD,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • Mengtao Dai MS,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • Lawrence J. Cook PhD, MStat,

    1. From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University (CN, SM), Portland, OR; the Department of Surgery (KS), Stanford University, Palo Alto, CA; the Division of Emergency Medicine, Department of Surgery, Stanford University (NEW), Palo Alto, CA; the Department of Emergency Medicine, University of California San Francisco, San Francisco General Hospital (RYH), San Francisco, CA; the Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine (NCM, MD, LJC), Salt Lake City, UT; the Department of Emergency Medicine, University of California at Davis (JFH, NK), Sacramento, CA; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; the Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine (JSH), Aurora, CO; and the Department of Surgery, University of Washington (EMB), Seattle, WA.
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  • the WESTRN investigators


  • This project was supported by the Robert Wood Johnson Foundation Physician Faculty Scholars Program; the Oregon Clinical and Translational Research Institute (grant UL1 RR024140); University of California, Davis Clinical and Translational Science Center (grant UL1 RR024146); Stanford Center for Clinical and Translational Education and Research (grant 1UL1 RR025744); University of Utah Center for Clinical and Translational Science (grant UL1-RR025764 and C06-RR11234); and UCSF Clinical and Translational Science Institute (grant UL1 RR024131). All Clinical and Translational Science Awards are from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: Manish Shah, MD.

Address for correspondence and reprints: Craig D. Newgard, MD, MPH; e-mail: newgardc@ohsu.edu.

Abstract

ACADEMIC EMERGENCY MEDICINE 2012; 19: 469–480 © 2012 by the Society for Academic Emergency Medicine

Abstract

Objectives:  The objective was to evaluate the process of using existing data sources, probabilistic linkage, and multiple imputation to create large population-based injury databases matched to outcomes.

Methods:  This was a retrospective cohort study of injured children and adults transported by 94 emergency medical systems (EMS) agencies to 122 hospitals in seven regions of the western United States over a 36-month period (2006 to 2008). All injured patients evaluated by EMS personnel within specific geographic catchment areas were included, regardless of field disposition or outcome. The authors performed probabilistic linkage of EMS records to four hospital and postdischarge data sources (emergency department [ED] data, patient discharge data, trauma registries, and vital statistics files) and then handled missing values using multiple imputation. The authors compare and evaluate matched records, match rates (proportion of matches among eligible patients), and injury outcomes within and across sites.

Results:  There were 381,719 injured patients evaluated by EMS personnel in the seven regions. Among transported patients, match rates ranged from 14.9% to 87.5% and were directly affected by the availability of hospital data sources and proportion of missing values for key linkage variables. For vital statistics records (1-year mortality), estimated match rates ranged from 88.0% to 98.7%. Use of multiple imputation (compared to complete case analysis) reduced bias for injury outcomes, although sample size, percentage missing, type of variable, and combined-site versus single-site imputation models all affected the resulting estimates and variance.

Conclusions:  This project demonstrates the feasibility and describes the process of constructing population-based injury databases across multiple phases of care using existing data sources and commonly available analytic methods. Attention to key linkage variables and decisions for handling missing values can be used to increase match rates between data sources, minimize bias, and preserve sampling design.

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