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Background: Traumatic injury is a leading cause of death and disability among US workers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state‐based occupational health indicator (OHI #22) was initiated in 2012 to track work‐related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD‐9‐CM) to ICD‐10‐CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work‐related hospitalizations. Methods: Seventeen states used hospital discharge data to calculate estimates for calendar years 2012–2019. State‐panel fixed‐effects regression was used to model linear trends in annual work‐related hospitalization rates, OHI #22 rates, and the proportion of work‐related hospitalizations resulting from severe injuries. Models included calendar year and pre‐ to post‐ICD‐10‐CM transition. Results: Work‐related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD‐10‐CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near‐monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work‐related hospitalizations before the ICD‐10‐CM transition, versus 9.1% post‐transition. Conclusions: Although hospital discharge data suggest decreasing work‐related hospitalizations over time, work‐related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD‐10‐CM transition‐associated structural break in 2015. [ABSTRACT FROM AUTHOR]

Context: While trauma designation has been associated with lower risk of death in large urban settings, relatively little attention has been given to this issue in small rural hospitals. Purpose: To examine factors related to in-hospital mortality and delayed transfer in small rural hospitals with and without trauma designation. Methods: Analysis of data from the Nationwide Inpatient Sample for discharges between 1998 and 2003 of patients hospitalized with moderate to major traumatic injury in nonfederal, short-stay rural hospitals with annual discharges of 1,500 or fewer patients (N = 9,590). Logistic regression was used to control for patient and hospital characteristics, stratifying by hospital volume. Main outcome measures were in-hospital death and transfer to another acute care facility after initial admission. Findings: A total of 333 patients (3.5%) died in-hospital. After adjusting for patient, injury and hospital characteristics, in-hospital death was more likely among patients treated at the non-designated hospitals with fewer than 500 discharges per year (OR 2.35; 95% CI 1.25-4.41) than among patients treated at similar trauma-designated hospitals. Patients admitted to non-designated hospitals were more likely to be transferred after admission, although this finding was significant only in the larger-volume hospitals with discharges of 500-1,500 per year (OR 1.41, 95% CI 1.08-1.83). Conclusions: Associations between trauma designation and outcomes in rural hospitals warrant further study to determine whether expanding designation to more rural hospitals might lead to further improvement in trauma outcomes.