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NCHRP Web-Only Document 302 Development of a Comprehensive Approach for Serious Traffic Crash Injury Measurement and Reporting Systems Carol A. Flannagan Jonathan D. Rupp University of Michigan Transportation Research Institute Ann Arbor, MI N. Clay Mann University of Utah School of Medicine Salt Lake City, UT Final Report for NCHRP Project 17-57 Submitted July 2015 NATIONAL COOPERATIVE HIGHWAY RESEARCH PROGRAM Systematic, well-designed, and implementable research is the most effective way to solve many problems facing state departments of transportation (DOTs) administrators and engineers. Often, highway problems are of local or regional interest and can best be studied by state DOTs individually or in cooperation with their state universities and others. However, the accelerating growth of highway transportation results in increasingly complex problems of wide interest to highway authorities. These problems are best studied through a coordinated program of cooperative research. Recognizing this need, the leadership of the American Association of State Highway and Transportation Officials (AASHTO) in 1962 initiated an objective national highway research program using modern scientific techniquesâthe National Cooperative Highway Research Program (NCHRP). NCHRP is supported on a continuing basis by funds from participating member states of AASHTO and receives the full cooperation and support of the Federal Highway Administration (FHWA), United States Department of Transportation, under Agreement No. 693JJ31950003. COPYRIGHT INFORMATION Authors herein are responsible for the authenticity of their materials and for obtaining written permissions from publishers or persons who own the copyright to any previously published or copyrighted material used herein. Cooperative Research Programs (CRP) grants permission to reproduce material in this publication for classroom and not-for-profit purposes. Permission is given with the understanding that none of the material will be used to imply TRB, AASHTO, FAA, FHWA, FTA, GHSA, NHTSA, or TDC endorsement of a particular product, method, or practice. It is expected that those reproducing the material in this document for educational and not-for-profit uses will give appropriate acknowledgment of the source of any reprinted or reproduced material. For other uses of the material, request permission from CRP. DISCLAIMER The opinions and conclusions expressed or implied in this report are those of the researchers who performed the research. They are not necessarily those of the Transportation Research Board; the National Academies of Sciences, Engineering, and Medicine; the FHWA; or the program sponsors. The information contained in this document was taken directly from the submission of the author(s). This material has not been edited by TRB.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, non- governmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. The Transportation Research Board is one of seven major programs of the National Academies of Sciences, Engineering, and Medicine. The mission of the Transportation Research Board is to provide leadership in transportation improvements and innovation through trusted, timely, impartial, and evidence-based information exchange, research, and advice regarding all modes of transportation. The Boardâs varied activities annually engage about 8,000 engineers, scientists, and other transportation researchers and practitioners from the public and private sectors and academia, all of whom contribute their expertise in the public interest. The program is supported by state transportation departments, federal agencies including the component administrations of the U.S. Department of Transportation, and other organizations and individuals interested in the development of transportation. Learn more about the Transportation Research Board at www.TRB.org.
C O O P E R A T I V E R E S E A R C H P R O G R A M S CRP STAFF FOR NCHRP WEB-ONLY DOCUMENT 302 Christopher J. Hedges, Director, Cooperative Research Programs Lori L. Sundstrom, Deputy Director, Cooperative Research Programs David Jared, Senior Program Officer Clara Schmetter, Senior Program Assistant Natalie Barnes, Director of Publications Jennifer Correro, Assistant Editor NCHRP PROJECT 17-57 PANEL Field of TrafficâArea of Safety John Milton, Washington State Department of Transportation, Olympia, WA (Chair) Leanna Depue, Governors Highway Safety Association (GHSA), Belton, TX Dia Gainor, National Association of State EMS Officials, Boise, ID Helen Holly Hackman, Boston Medical Center, Boston, MA Timothy Kerns, Maryland Department of Transportation, Glen Burnie, MD Jana Simpler, Delaware Office of Highway Safety, Dover, DE David E. Sugerman, CDC Division of Injury Response, Atlanta, GA Ana Maria Eigen, FHWA Liaison John Kindelberger, NHTSA Liaison Noah Smith, NHTSA Liaison Kelly Hardy, AASHTO Liaison Holly Hedegaard, National Center for Health Statistics Liaison Jacob A. Nelson, AAA National Office Liaison Bernardo Kleiner, TRB Liaison .
iii Contents 1 Summary .................................................................................................................................. 1 2 Overview .................................................................................................................................. 6 3 Measuring Serious Injury ...................................................................................................... 7 3.1 Injury Classification Systems .......................................................................................................... 7 3.2 Severity Metrics .............................................................................................................................. 8 3.3 Evaluation Criteria ........................................................................................................................ 11 3.4 Conclusions ................................................................................................................................... 13 4 Data Linkage in States .......................................................................................................... 14 4.1 Definition of Serious Injury .......................................................................................................... 14 4.2 Linkage Activities ......................................................................................................................... 15 4.3 Database Coverage ........................................................................................................................ 19 4.4 Challenges, Priority and Timing ................................................................................................... 20 5 Near-Term Solutions to Measuring Serious Injury ........................................................... 22 5.1 Overview of Near-Term Solutions ................................................................................................ 22 5.2 Using State Trauma Databases ...................................................................................................... 23 5.3 Sampling Solution ......................................................................................................................... 23 5.4 Regression Solution ....................................................................................................................... 25 6 Roadmap to Comprehensive Measurement of Serious Injuries Through Linkage ........ 29 6.1 Why Link? ..................................................................................................................................... 29 6.2 Requirements for Linkage ............................................................................................................. 30 6.3 Dataset Quality .............................................................................................................................. 30 6.3.1 Coverage ................................................................................................................................ 30 6.3.2 Schema Consistency .............................................................................................................. 31 6.3.3 Quality Control ...................................................................................................................... 31 6.3.4 Timeliness .............................................................................................................................. 32 6.4 State Datasets ................................................................................................................................ 32 6.4.1 Crash ...................................................................................................................................... 32 6.4.2 Emergency Medical Services (EMS) ..................................................................................... 32 6.4.3 Trauma ................................................................................................................................... 33 6.4.4 Hospital Discharge ................................................................................................................. 33 6.4.5 Emergency Department ......................................................................................................... 34 6.4.6 Roadway Databases ............................................................................................................... 34 6.4.7 Driver Licensing .................................................................................................................... 35 6.4.8 Driver History ........................................................................................................................ 35 6.5 Common Identifiers ....................................................................................................................... 35 6.6 Access Rules & Permissions ......................................................................................................... 36 7 Roadmap to Linkage............................................................................................................. 37 7.1 Roadmap Overview ....................................................................................................................... 37 7.2 Step 1: Arrange Collaboration Among Relevant Agencies ........................................................... 38 7.3 Step 2: Catalog Available Databases ............................................................................................. 38 7.3.1 Data Dictionary ...................................................................................................................... 38 7.3.2 Inclusion Criteria ................................................................................................................... 38 7.3.3 Coverage ................................................................................................................................ 39 7.3.4 Quality Control ...................................................................................................................... 39
iv 7.4 Step 3: Determine Databases to Be Linked ................................................................................... 40 7.5 Step 4: Identify the Identifiers ....................................................................................................... 41 7.6 Step 5: Determine Linkage Mechanisms ....................................................................................... 42 7.6.1 Adding Identifiers After the Fact ........................................................................................... 42 7.6.2 Assigning Identifiers At The Time of the Event .................................................................... 46 7.6.3 Summary of Linkage Mechanisms Used by States ................................................................ 48 7.7 Step 6: Determine Database Storage Mechanism ......................................................................... 49 7.7.1 Data Warehouse ..................................................................................................................... 49 7.7.2 Separate Linked Dataset ........................................................................................................ 51 7.8 Step 7: Harmonize Common Data Elements ................................................................................. 51 7.9 Step 8: Set Up a Pilot Project ........................................................................................................ 52 7.10 Step 9 (Optional): Set Up a Sampling Program ............................................................................ 53 7.11 Step 10: Set Up Statewide Linkage ............................................................................................... 53 8 Discussion............................................................................................................................... 54 8.1 Making Progress in Parallel .......................................................................................................... 54 8.2 Benefits of a National Standardized Schema and National Datasets ............................................ 54 8.3 Motivators ..................................................................................................................................... 55 8.4 Where We Are Now ...................................................................................................................... 55 9 Recommendations ................................................................................................................. 57 10 References ............................................................................................................................ 59 11 Appendix A: Serious Injury Definitions ........................................................................... 61 12 Appendix B: Identifiers for Linkage ................................................................................. 66
