U.S. Department 

of Transportation

National Highway

Traffic Safety 

Administration

DOT HS 808 581 April 1997

NHTSA Report

CATALOG

OF

TYPES OF

APPLICATIONS

IMPLEMENTED USING

LINKED STATE DATA

Crash Outcome Data Evaluation System

(CODES)
CATALOG

OF

TYPES OF

 APPLICATIONS

IMPLEMENTED USING 

LINKED STATE DATA

Crash Outcome Data Evaluation System (CODES)

April 1997

National Center for Statistics and Analysis

National Highway Traffic Safety Administration

400 Seventh Street, SW, Room 6125

Washington, D.C. 20590
ii

TABLE OF CONTENTS

1.0 INTRODUCTION ............................................1

1.1 Purpose of the Catalog ....................................1

1.2 Evolution of CODES ......................................1

1.3 A Description of CODES ..................................1

1.4 First Implementation of CODES ............................2

2.0 BACKGROUND ............................................3

2.1. Data Resources and Case Selection .........................3

2.2 Issues Related to “As Reported” Data and the Linkage Process ...4

2.2.1 Utilization of Safety Measures .........................4

2.2.2 Defining an Injury ..................................4

2.2.3 Identifying the Type of Injury .........................4

2.2.4 Identifying Costs and Charges .........................5

2.2.5 The Linkage Process: ................................5

2.3 Organization of the Catalog ................................5

3.0 APPLICATIONS FOR INJURY PREVENTION ...................7

3.1 Evaluating the Occurrence of Injury .........................7

3.1.1 By Age and Sex ....................................7

1. The usefulness of linked data in exploring issues

associated with motor vehicle crashes involving

drivers ages 16 through 20 years in Alaska 

(in process). ..................................7

2. Evaluation of the Elderly Driver in Motor Vehicle

Crashes in Connecticut (in process) ...............7

3. Injury Rates and Outcome for Males by Age in 

Accidents in Maine ............................8

4. Injury Rates and Outcome for Females by Age in

Accidents in Maine ............................8

5. Hospitalized Driver’s Injuries by Age Group: a 

Focus on Older Drivers in New York ..............9

6. Crashes Involving Older Drivers in New York (in

process) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
iii

7. Graduated Licensing: Using Linked Data to 

Evaluate Its Medical and Financial Impact in Utah . . 10

3.1.2 Involving Pedestrians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

1. Injury Outcome by Age Group for Male 

Pedestrians in Accidents in Maine . . . . . . . . . . . . . . . 11

2. Injury Outcome by Age Group for Female 

Pedestrians in Accidents in Maine . . . . . . . . . . . . . . . 11

3. Injury Outcome by County of Accident Location 

for Pedestrians Involved in Accidents in Maine . . . . . 12

4. Injury Outcome by Month of Accident for 

Pedestrians in Accidents in Maine . . . . . . . . . . . . . . . 12

5. Injury Outcome by Day of Week of Accident for

Pedestrians in Accidents in Maine . . . . . . . . . . . . . . . 13

6. Injury Outcome by Time of Accident (1 hour 

intervals) for Pedestrians in Accidents in Maine . . . . . 13

7. Injury Outcome for Pedestrians Involved in 

Alcohol-Related Accidents in Maine . . . . . . . . . . . . . . 14

8. Injury Outcome for Pedestrians Involved in Motor

Vehicle Crashes by Population Density of Accident

Location in Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

9. Injury Outcome for Pedestrians Involved in 

Crashes by Roadway Location of Accident in Maine . . 15

10. Injury Outcome for Pedestrians Involved in Motor

Vehicle Crashes by Apparent Contributing Factor 

in Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3.1.3 Involving Bicyclists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

1. Injury Outcome by Age Group for Male Bicyclists

Involved in Accidents in Maine . . . . . . . . . . . . . . . . . . 16

2. Injury Outcome by Age Group for Female Bicyclists

Involved in Accidents in Maine . . . . . . . . . . . . . . . . . . 16

3. Injury Outcome by County of Accident Location for

Bicyclists Involved in Accidents in Maine . . . . . . . . . . 17

4. Injury Outcome by Month of Accident for Bicyclists

Involved in Accidents in Maine . . . . . . . . . . . . . . . . . . 17

5. Injury Outcome by Day of Week of Accident for Bicyclists

Involved in Accidents in Maine . . . . . . . . . . . . . . . . . . 18
iv

6. Injury Outcome by Time of Accident (1 hour intervals)

for Bicyclists Involved in Accidents in Maine . . . . . . . 18

7. Injury Outcome for Bicyclists Involved in AlcoholRelated Accidents in Maine . . . . . . . . . . . . . . . . . . . . . 19

8. Injury Outcome for Bicyclists Involved in Motor 

Vehicle Crashes by Population Density of Accident

Location in Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

9. Injury Outcome for Bicyclists Involved in Crashes 

by Roadway Location of Accident in Maine . . . . . . . . 20

10. Injury Outcome for Bicyclists Involved in Motor 

Vehicle Crashes by Apparent Contributing Factor 

in Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

3.1.4 By Geographic Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

1. Analysis of the Medical and Financial Outcomes 

of Crash Injuries Occurring in Connecticut(in 

process) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

2. Injury Outcome by County in Maine . . . . . . . . . . . . . . 21

3. Injury Outcome by Hospital Service Area in Maine . . 22

4. Injury Outcome by Population Density of Crash Location

in Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

3.1.5 By Date and Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

1. Injury Outcome by Month of Accident in Maine . . . . . 23

2. Injury Outcome by Day of Week of Accident in 

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

3. Injury Outcome by Time of Accident in Maine . . . . . . 24

3.1.6 By Type of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

1. Incidence and Cost of Traumatic Brain Injury in 

New Mexico (in process) . . . . . . . . . . . . . . . . . . . . . . . 25

3.2 Occurrence of Health Care Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

3.2.1 Costs and Safety Belt Use . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

1. Focus...Injuries and Costs Associated with Failure 

to Use Seat Belts in Missouri . . . . . . . . . . . . . . . . . . . 26

3.2.2 Who Pays? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

1. Who Incurs and Pays for Hospital Care for Motor

Vehicle Accident Victims in Pennsylvania?(in 

process) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
v

3.2.3 Medicaid and Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

1. The Cost of Motor Vehicle Crash Injuries to the

Wisconsin Medicaid Program . . . . . . . . . . . . . . . . . . . 27

3.2.4 Comparing Hospital Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

1. Computing Hospital Costs Savings Using the Entire

Crash Population Rather than Only Hospitalized 

Cases in Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

4.0 APPLICATIONS FOR TRAFFIC SAFETY . . . . . . . . . . . . . . . . . . . . . . 29

4.1 Crash Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

1. Injury Outcome by Posted Speed Limit in Maine . . . . . 29

2. Injury Outcome by Accident Type in Maine . . . . . . . . 29

3. Injury Outcome by Roadway Location of Accident 

in Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

4. Injury Outcome by Light Conditions of Accident in Maine30

5. Injury Outcome by Road Surface of Accident in 

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

6. Injury Outcome by Type of Road Work at Accident 

in Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

7. Injury Outcome by Apparent Contributing Factors 

in Single Vehicle Crashes in Maine . . . . . . . . . . . . . . . 32

8. Injury Outcome by Apparent Contributing Factors 

in Multiple Vehicle Crashes in Maine . . . . . . . . . . . . . 32

9. Crash Parameters and Cost of Care in New York ( in

process) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

4.2 Vehicle Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

1. Injury Outcome by Vehicle Type in Maine . . . . . . . . . 34

2. Injury Outcome by Type of Emergency Vehicle 

Involved in Accident in Maine . . . . . . . . . . . . . . . . . . . 34

3. Assessing Crash Severity through Vehicle Damage, Point

of Damage on Vehicle, Number of Vehicles in Crash,

Posted Speed and Impact Speed in Utah . . . . . . . . . . . 35

4.3 Person Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
vi

4.3.1 Safety Belts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

1. Report to Congress on Benefits of Safety Belts and

Motorcycle Helmets, Based on Data from the Crash

Outcome Data Evaluation System (CODES) . . . . . . . . 36

2. NHTSA Technical Report: The Crash Outcome

Evaluation System (CODES) . . . . . . . . . . . . . . . . . . . . 36

3. Safety Belts and Head and Spinal Injuries in Maine . . 37

4. Within Vehicle Analysis of the Effectiveness of Seat 

Belts in Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

5. Application of Ordered Logistic Regression to 

Evaluate the Efficacy of Seat Belts and Helmets for

Prevention of Injury in Maine . . . . . . . . . . . . . . . . . . . 38

6. Injury Outcome by Seating Position in Cars and 

Light Trucks Only Involved in Accidents in Maine . . . 38

7. Injury Outcome by Number of People in Cars and 

Light Trucks Involved in Accidents in Maine . . . . . . . . 39

8. Total Occupants, and Number and Percent Injured 

By Type of Ejection in Accident in Maine . . . . . . . . . . 39

9. Unsafe Driving Behaviors and Hospitalization in

Missouri. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

4.3.2 Air Bags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

1. Air Bag Effectiveness in Pennsylvania (in process) . . . 41

4.3.3 Helmet Utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

1. Head Injuries Associated with Motorcycle Use in

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

2. Injuries and Costs Associated with Failure to Use

Motorcycle Helmets in Missouri . . . . . . . . . . . . . . . . . 42

4.3.4 Alcohol and Drug Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

1. Injury Outcome in Alcohol-Related Accidents in 

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

2. Injury Outcome for Pedestrians/Bicyclists Involved 

in Alcohol Related Crashes by Apparent Physical

Condition of Driver in Maine . . . . . . . . . . . . . . . . . . . 43

3. Injury Outcome by Apparent Physical Condition of

Driver in Single Vehicle Accidents in Maine . . . . . . . . 44

5.0 APPLICATIONS FOR HIGHWAY SAFETY . . . . . . . . . . . . . . . . . . . . . 45
vii

5.1 Roadway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

5.1.1 Objects in Roadway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

1. Evaluation of Severity and Outcome of Injury by 

Type of Object Struck in Connecticut (in process) . . . . 45

2. Injury Outcome for Crashes Involving Moose, Deer 

or Other/Unknown in Maine . . . . . . . . . . . . . . . . . . . . 45

3. Collisions With Utility Poles, Guide rails, and 

Median Barriers in New York (in process) . . . . . . . . . 46

4. Effectiveness of Guide Rails in Reducing Severity, 

Injury and Death in Single Vehicle Fixed Object

Collisions in Pennsylvania. (in process) . . . . . . . . . . . 46

6.0 APPLICATIONS FOR EMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

6.1 Occurrence of EMS Transports . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

1. EMS Response Times by Population Density in 

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

2. Geographic Information System for Emergency 

Medical Services Analysis in Hawaii . . . . . . . . . . . . . 47

6.2 Injury Severity and EMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

1. Severity of Injury and Average on Scene time for 

EMS Transports Related to Motor Vehicle Crashes 

in Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

2. CODES Victim Severity as Predicted by EMS 

Variables in Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

7.0 APPLICATIONS RELATED TO THE QUALITY OF STATE DATA . 49

7.1 Under-Reporting of Collisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

1. Estimate of Police Under-Reporting of Collisions in

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

7.2 Over-reporting of Belt Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

1. Comparative Reporting of Belt Use, Alcohol, and 

Type of Injury from Police, EMS, and Hospital Discharge

Abstract Reports in Maine . . . . . . . . . . . . . . . . . . . . . 50

2. Variations in Reported Belt Use in Different State 

Data Files in Missouri . . . . . . . . . . . . . . . . . . . . . . . . 50

3. Over-Reporting and Measured Effectiveness of Seat Belts
viii

in Motor Vehicle Crashes in Utah . . . . . . . . . . . . . . . 51

4. Estimates of the Effects of Seat Belt Over-Reporting 

on Wisconsin Motor Vehicle Crash Analyses in

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

7.3 Errors in Financial Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

1. Linked hospital discharge and Head and Spinal

Cord/Trauma Injury Data (HSCIT) to Compare 

Hospital Charges in Missouri . . . . . . . . . . . . . . . . . . . 52

2. The Effects of Data Outliers and Errors in Hospital

Charges on Conclusions Regarding the Efficacy of Safety

Belt Use in Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . 52

7.4 Developing State Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

1. Developing Statewide Emergency Department Data 

in Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

8.0 APPLICATIONS RELATED TO THE LINKED STATE DATA . . . . . . 54

8.1 Validating the Linkage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

1. Identifying Records That Should Have Linked but 

Did Not, and Comparing Them to Records That Did 

Link in Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

2. Comparing Linkage Methods: Ad Hoc Linkage 

Versus Probabilistic Linkage in Missouri . . . . . . . . . . 54

3. Comparison of Two Hospital Data Files Using the

Capture-recapture Formula in Missouri . . . . . . . . . . . 55
1

1.0 INTRODUCTION

1.1 Purpose of the Catalog

The purpose of this catalog is to inspire the development of new applications for linked data that

support efforts to reduce death, disability, severity, and health care costs related to motor vehicle

crashes. The document is divided into three sections. The Introduction describes the purpose of

the Catalog, the evolution and components of CODES, and the CODES states. The Background

section discusses data resources and case selection, issues related to “as reported” data and the

linkage process, and the organization of information included in the catalog. The final section

presents abstracts of some of the types of state-specific applications developed or in process to

date. NHTSA will update the catalog as new applications are developed.

1.2 Evolution of CODES

The Crash Outcome Data Evaluation System (CODES) project evolved from the Intermodal

Surface Transportation Efficiency Act (ISTEA) of 1991 which mandated that the National

Traffic Safety Administration (NHTSA) report to Congress about the benefits of safety belts

and motorcycle helmets in motor vehicle crashes. Benefits were to be measured in terms of

reductions in death, disability, and medical costs. Since none of the crash and various injury

state data files contains sufficient information to identify the specific crash, vehicle, and behavior

characteristics that make a difference to outcome, NHTSA determined that only linked statewide

data could provide the necessary outcome information for all persons involved -- those who were

injured or who died and those who were not injured. Using these data, comparisons between

those using and not using safety belts or motorcycle helmets could be made by identifying and

contrasting the characteristics of the injured and uninjured persons within each of the use groups. 

Also by using state data, the linked data could be used to support state specific purposes and

could be disaggregated to support safety efforts at the local and regional levels.

1.3 A Description of CODES

CODES consists of linked statewide crash and injury data that match vehicle, crash, and human

behavior characteristics to their specific medical and financial outcomes. These state data are

located in multiple sources: crash data collected by police at the scene; EMS data collected by

EMTs who provide treatment at the scene and enroute; medical data collected by physicians,

nurses and others who provide treatment at the emergency department, in the hospital, or

outpatient setting; and third party payors who pay. Linkage enables persons involved in the

motor vehicle crash to be traced from the scene to their final medical and financial outcomes. To

implement CODES, states, as a minimum, need computerized statewide crash, hospital, and EMS

or emergency department data that have sufficient information to discriminate among the crash

events and persons involved in each event. When these data are also linked to driver licensing,

vehicle registration, citation/conviction records, insurance claims, HMO/managed care/etc.

outpatient records, etc., the linked data are more comprehensive and thus even more useful for
2

 Exhibit 1

state specific purposes. Although state data are frequently imperfect, linkage is feasible using a

probabilistic linkage technology that identifies valid matches without requiring exact matches

among the attribute values. This technology makes it possible to process a phenomenal amount

of data in a short amount of time. Successful implementation of CODES depends upon an

Advisory Committee consisting of the owners and major users of the state data who

collaboratively resolve issues related to data access, patient confidentiality, management and

release of the linked data and institutionalization of CODES. An added benefit of data linkage

is that data quality improves when missing and inaccurate data highlighted during the linkage

process are corrected. 

1.4 First Implementation of CODES

NHTSA funded Hawaii, Maine, Missouri, New York, Pennsylvania, Utah, and Wisconsin to

implement Crash Outcome Data Evaluation Systems (CODES) to generate linked state crash

and injury data for the required analyses and for state specific purposes. Statewide police

reported crash reports were linked to emergency medical services, emergency department,

hospital discharge, rehabilitation, long term care, death certificate and/or claims data as shown

in Exhibit 1. Each states linked data base varies in terms of the number of data files linked

but all of them include at least 12 months of person-specific, population-based, statewide data

that permit tracking of persons involved in motor vehicle crashes from the scene to final

disposition. Each state controls access to its linked data. Subsequently, NHTSA funded three

of the CODES states (New York, Pennsylvania, Wisconsin) and three other states (Alaska,

Connecticut, and New Mexico) to develop additional state-specific applications for their linked

state data.
3

2.0 BACKGROUND

2.1. Data Resources and Case Selection

For computerized data files to be linked, they must exist. Unfortunately, not all states have crash

and injury data that are statewide and computerized. Almost all of the states have computerized

crash data statewide. Half of the states have developed state EMS data systems, but only a few

have state emergency department data systems. A majority of the states have computerized state

hospital discharge data systems. All of the states have computerized Medicaid and Medicare data

systems, but few states have statewide computerized data files for private vehicle or health

insurance claims data. Access to data for the less seriously injured victims, a group that includes

many of the successes for highway safety, is difficult to obtain because the data may not be

computerized. Or if computerized, they are computerized by provider or by insurance group and

rarely statewide. Injury data are particularly useful to highway safety because they document

what happens to all victims injured in motor vehicle crashes, regardless of whether the crash itself

meets police reporting thresholds. 

The states chosen for the CODES funding were those that had the best state data. All of the

CODES states had statewide crash and hospital data. Six of the seven states had statewide EMS

data. More information about the experience of the CODES states performing the data linkage

may be obtained from the Technical Report: Crash Outcome Data Evaluation System Project

published by NHTSA. Exhibit 2 below presents the study populations that can be generated from

the linkage of different groups of state data files. 

Exhibit 2: Populations Generated by Groups of Linked Data

Linked Hospitalized Transported by Treated in ED Treated as

Statewide Data EMS Regardless of Outpatients at

Crash Linked Office

to:

EMS Transport Physician’s

Hospital X

EMS, Hospital X X

EMS, ED, Hosp. X X X

Medicare X X X X

/Medicaid

Insurance
4

2.2 Issues Related to “As Reported” Data and the Linkage Process

The usefulness of existing computerized state data collected for other purposes and then linked to

fulfill highway safety data needs depends upon the quality of “as reported” state data. The user

must understand what and how the state data are collected since data quality reflects the

environment of the crash and the existence of legislative mandates. The following issues must be

considered when developing applications for linked crash and injury state data.

2.2.1 Utilization of Safety Measures: Crash data document the events of a crash

including utilization information to support police enforcement activities related to safety

devices. Over or under reporting of utilization may be related to the existence and

enforcement of laws and insurance regulations mandating their use, or non-use in the case

of alcohol. For example, when a state penalizes occupants who fail to buckle up, the

unbelted occupant involved in a crash may be tempted to report belt use, particularly when

the crash or injury is minor. Thus, “as reported” data alone may inflate the calculations of

effectiveness. Combining “as reported” with observed data is likely to generate more

realistic rates.

2.2.2 Defining an Injury: Injury data include medical information about the occurrence

of injuries and their costs. Without linkage to the crash data, victims injured in a motor

vehicle crash can be identified in the injury data only when the medical record documents

the external cause of injury (motor vehicle crash, fall, etc.), for example by an E-code. 

Use of the E-code is useful to identify records for injuries caused by a motor vehicle crash

that failed to link to a crash report or were not reportable because the crash occurred on a

non-public road. Thus, use of both crash and injury data together is more likely to

identify more of the total injuries resulting from motor vehicle crashes than use of the

crash or injury data alone. 

2.2.3 Identifying the Type of Injury: Documentation of the type of injury varies in the

different state data files. Non-medical data sources, such as the crash report, may

document the area and type of injury in general terms such as head, neck, bleeding and

broken bone. Injury severity in this type of data is documented in functional terms to

indicate the need for help from the scene (killed, incapacitated, non-incapacitated,

possible, none). Medical data sources use more specific terms. EMS data indicate

specific types and areas of injury augmented by information describing the treatment

provided and record injury severity using the patient’s vital signs. Hospital data document

the area and type of injury using medical terms coded according to the International

Classification of Diseases, 9th edition, Clinical Modifications (ICD-9-CM). Injury severity

is then defined in anatomical terms based on the ICD-9-CM codes. Thus, a group of head

injured patients selected from the crash data is likely to include non-head injuries

compared to a group of head injured patients selected from the more precise hospital data. 
5

2.2.4 Identifying Costs and Charges: Injury data document the total charges

associated with providing medical care to a specific patient but do not document the actual

cost of providing care or the actual revenue received by the provider of the care. Charge

information is recorded for patients discharged from an acute care hospital. Sometimes

this information is also available from billing records for patients transported by EMS or

treated in the emergency department. It is important to note that total charges represent

the “price” charged for treatment. Charge information documented in EMS, emergency

department, and hospital data systems may not include charges by private physicians who

are not on the staff of the facility/agency where the patient is treated. Charge information

also does not include the indirect costs, such as loss of productivity or long term care and

social support, incurred by those suffering long term disability. The bottom line is that

total charges are commonly used to report “costs” of health care. However, the user must

remember that the charge information that is available understate the total expenses

incurred as the result of motor vehicle crashes.

2.2.5 The Linkage Process: Some measures, such as effectiveness rates, for

countermeasures are not affected by the linkage process unless the false negative rate

(records for injured victims that should have linked but did not) is high enough to

misrepresent the injured population. However, the failure to link may cause totals, such as

total EMS transports, hospitalizations, charges, and hospital days, to be understated. In

addition, average charges may be understated if the unlinked records contain injured

persons with unusually high hospital charges and long lengths of stay. 

Records with more discriminating information about the events and persons involved are

more likely to match than records with less information. For example, date of birth is

frequently available on the crash report only for drivers. Without the capability to obtain

date of birth for non-drivers through ancillary linkages, injury records for drivers are more

likely to link than those for non-drivers. The potential for systematic biases to occur can

be estimated by reviewing variations in submission and data quality rates by police agency,

provider, or geographic service area to ensure that specific population groups, types of

services, etc. are not under- or over-reported for either the injured or uninjured.

Thus, before performing any analyses, the accuracy and completeness of the linked data

must be evaluated relative to the type of study population and the outcome measures used

for the study.

2.3 Organization of the Catalog

This catalog presents some of the types of state specific applications developed or in process to

date by the original seven CODES states (Hawaii, Maine, Missouri, New York, Pennsylvania,

Wisconsin, Utah) and three additional states (Alaska, Connecticut, New Mexico). These

applications reflect how the linked state data are being used to support state-specific efforts. The

types of applications are listed under one of six subject areas: Injury Prevention, Traffic Safety,
6

Highway Safety, EMS, Data Quality, and Validating Linked Data. Each application is listed only

once though it may be applicable to more than one area. Exhibit 3 presents the topic areas

included within each subject area. The state-specific applications are organized alphabetically by

state within each area.

Exhibit 3: Classification of State Specific APPLICATIONS for Linked Data by Subject Area and Topic

Subject Area Topic Areas

3.1 Injury Prevention 3.1.1 Occurrence

3.1.2 Costs

3.2 Traffic Safety 3.2.1 Crash Characteristics

3.2.2 Vehicle Characteristics

3.2.3 Person Characteristics

3.3 Highway Safety 3.3.1 Roadway

3.4 EMS

3.5 Quality of State Data

3.6 Validating Linked Data

Information describing each state specific application is presented using the following format:

(Title and Authors)

Scope (time period and definition of study population)

Data Used (names of state data files linked for the application)

Format (indication that application is a study, management report, overheads or chart )

Description (summary of the types of information generated by the application)

Contact Person (person to contact for more information about the application)

Copies of the studies, management reports, overheads and charts presented in this catalog may be

obtained directly from the contact person listed for each application. 
7

3.0 APPLICATIONS FOR INJURY PREVENTION

3.1 Evaluating the Occurrence of Injury

3.1.1 By Age and Sex 

1. The usefulness of linked data in exploring issues associated with motor vehicle crashes

involving drivers ages 16 through 20 years in Alaska (in process).

Scope All persons involved in 1991-1995 crashes statewide in Alaska

Data Used Crash linked to Public Safety, EMS, Trauma Registry (includes all injuries

statewide that are admitted to a hospital, transferred to another acute care

facility, or declared dead in the ED), and Medicaid data.

Format Study

Description This study uses the linked data to examine the role of youth and

inexperience (drivers age 16 through 20) in motor vehicle crashes, the role

of driver permits in reducing crashes among this age group, the

contributing factors of crashes involving drivers from this age group, the

medical outcomes of crashes involving youth and the costs associated with

these crashes (including the payers of these costs). The goal of the project

is to use linked data to enact a graduated licensing law in Alaska in order to

reduce death, disability, and costs for drivers aged 16-20.

Contact Person Mark S. Johnson, TEL: 907-465-3027; FAX: 907-586-1877

2. Evaluation of the Elderly Driver in Motor Vehicle Crashes in Connecticut (in process)

Scope All persons involved in 1994 and 1995 crashes statewide in Connecticut

Data Used Crash data linked to emergency department, ambulatory surgery, hospital

discharge, trauma registry, death certificate and census data.

Format Study

Description This study reports the incidence of motor vehicle crashes for elderly drivers

compared to younger drivers, the expected roadway locations and

predictors for crashes involving the elderly, and injury outcomes for elderly

victims in terms of cost, diagnosis, average length of stay, total hospital

days, final disposition, and mortality at 30, 60, and 90 days.

Contact Person Angela S. Mattie TEL: 203-294-7224; FAX: 203-284-9318
8

3. Injury Rates and Outcome for Males by Age in Accidents in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents population-based injury rates and

outcome for males involved in motor vehicle crashes including the total

occupants, total injured, injury rate per 100,000, total transported by EMS,

total admitted to a hospital, total with severe injury ISS>15, total charges,

total with head/spinal injuries, total deaths, and total years of potential life

lost. Data are reported by age grouped in five year intervals.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

4. Injury Rates and Outcome for Females by Age in Accidents in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents population-based injury rates and

outcome by age for females involved in motor vehicle crashes including the

total occupants, total injured, injury rate per 100,000, total transported by

EMS, total admitted to a hospital, total with severe injury ISS>15, total

charges, total with head/spinal injuries, total deaths, and total years of

potential life lost. Data are reported by age grouped in five year intervals.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

5. Hospitalized Driver’s Injuries by Age Group: a Focus on Older Drivers in New York

Joanne Guardino 
9

 

Scope All persons involved in 1992 motor vehicle crashes statewide in New York

Data Used Crash linked to EMS and hospital discharge data

Format Study

Description This study evaluates the increased risk for injury from a motor vehicle crash

by age group, particularly the elderly population. All drivers were assigned

to groups covering a span of 10 years (16-24, 25-34, etc.). Factors, such

as speed, contributing to the crash, use of protective devices were

considered. Type of injury, length of stay, and hospital charges were

compared for each age group.

Contact Person Richard Guerin TEL: 518-474-2219; FAX: 518-486-6216

6. Crashes Involving Older Drivers in New York (in process)

Scope All persons involved in 1994 motor vehicle crashes statewide in New York

Data Used Crash linked to EMS and hospital discharge data

Format Study

Description This study provides information about the impact of driver age on the

type/severity of injuries and medical costs after consideration of safety

equipment and vehicle type. Severity will be measured using ICD-9-CM,

AIS, and ISS scores.

Contact Person Richard Guerin TEL: 518-474-2219; FAX: 518-486-6216
10

7. Graduated Licensing: Using Linked Data to Evaluate Its Medical and Financial Impact

in Utah

Pat Nechodom

Scope All persons involved in 1991 motor vehicle crashes statewide in Utah

Data Used Crash linked to EMS, emergency department and hospital data

Format Presentation Overheads

Description This presentation describes the need for and expected impact of graduated

licensing on the occurrence of injury and financial charges for hospital

inpatients and outpatients. 

Contact Person Pat Nechodom TEL: 801-581-6410; FAX: 801-581-8686
11

3.1.2 Involving Pedestrians

1. Injury Outcome by Age Group for Male Pedestrians in Accidents in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents injury outcome for male pedestrians

including the total involved, total injured, percent of total injured, total

transported by EMS, total admitted to a hospital, total with severe injury

ISS>15, total charges, total with head/spinal injuries, total deaths and total

years of potential life lost. Data are reported by age grouped into five year

intervals.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

2. Injury Outcome by Age Group for Female Pedestrians in Accidents in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents injury outcome for female pedestrians

including the total involved, total injured, percent of total injured, total

transported by EMS, total admitted to a hospital, total with severe injury

ISS>15, total charges, total with head/spinal injuries, total deaths and total

years of potential life lost. Data are reported by age grouped into five year

intervals.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
12

3. Injury Outcome by County of Accident Location for Pedestrians Involved in Accidents in

Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents the injury outcome by county of crash

location for pedestrians involved in crashes including the total involved,

total injured, injury rate per 100,000, total transported by EMS, total

admitted to a hospital, total with severe injury ISS>15, total charges, total

with head/spinal injuries, total deaths and total years of potential life lost. 

Data are reported for the 16 counties in Maine.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

4. Injury Outcome by Month of Accident for Pedestrians in Accidents in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents the injury outcome by month of the crash

for pedestrians involved in crashes including the total involved, total

injured, injury rate per 100,000, total transported by EMS, total admitted to

a hospital, total with severe injury ISS>15, total charges, total with

head/spinal injuries, total deaths and total years of potential life lost.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
13

5. Injury Outcome by Day of Week of Accident for Pedestrians in Accidents in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents the injury outcome by day of week of the

crash for pedestrians involved in crashes including the total involved, total

injured, injury rate per 100,000, total transported by EMS, total admitted to

a hospital, total with severe injury ISS>15, total charges, total with

head/spinal injuries, total deaths and total years of potential life lost.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

6. Injury Outcome by Time of Accident (1 hour intervals) for Pedestrians in Accidents in

Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents by time of the crash, using one hour

intervals, for pedestrians involved in crashes the injury outcome including

the total involved, total injured, injury rate per 100,000, total transported

by EMS, total admitted to a hospital, total with severe injury ISS>15, total

charges, total with head/spinal injuries, total deaths and total years of

potential life lost.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
14

7. Injury Outcome for Pedestrians Involved in Alcohol-Related Accidents in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents injury outcome for pedestrians involved

in alcohol and non alcohol-related crashes including the total involved, total

injured, total transported by EMS, total admitted to a hospital, total with

severe injury ISS>15, total charges, total with head/spinal injuries, total

deaths, total years of potential life lost, and relative risk.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

8. Injury Outcome for Pedestrians Involved in Motor Vehicle Crashes by Population

Density of Accident Location in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents for pedestrians involved in motor vehicle

crashes by population density of crash location, the injury outcome

including the total involved, total injured, total transported by EMS, total

admitted to a hospital, total with severe injury ISS>15, total charges, total

with head/spinal injuries, total deaths, total years of potential life lost, and

relative risk of injury. Crash location is defined as population per square

mile as follows: metro (>500), urban (101-500), Suburban (51-100), rural

(7-50), wilderness (<7), unknown.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
15

9. Injury Outcome for Pedestrians Involved in Crashes by Roadway Location of Accident in

Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents for pedestrians involved in crashes by

roadway location of the crash the total involved, total injured, percent of

total injured, total transported by EMS, total admitted to a hospital, total

with severe injury ISS>15, total charges, total with head/spinal injuries,

total deaths, years of potential life lost and the relative risk. Location of

crash is defined as straight road, curved, 3 legged intersection, 4 legged

intersection, 5 legged intersection, driveways, bridges, interchange, other,

missing/invalid.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

10. Injury Outcome for Pedestrians Involved in Motor Vehicle Crashes by Apparent

Contributing Factor in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents for pedestrians involved in motor vehicle

crashes by apparent contributing factor in single vehicle crashes, the total

involved, total injured, percent of total injured, total transported by EMS,

total admitted to a hospital, total with severe injury ISS>15, total charges,

total with head/spinal injuries, total deaths and years of potential life lost. 

Results are shown separately for thirty different apparent contributing

factors. 

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
16

3.1.3 Involving Bicyclists

1. Injury Outcome by Age Group for Male Bicyclists Involved in Accidents in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents the injury outcome by age in five year

intervals for male bicyclists including the total involved, total injured,

percent of total injured, total transported by EMS, total admitted to a

hospital, total with severe injury ISS>15, total charges, total with

head/spinal injuries, total deaths and total years of potential life lost.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

2. Injury Outcome by Age Group for Female Bicyclists Involved in Accidents in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents for female bicyclists involved in crashes

the injury outcome by age in five year intervals including the total involved,

total injured, percent of total injured, total transported by EMS, total

admitted to a hospital, total with severe injury ISS>15, total charges, total

with head/spinal injuries, total deaths and total years of potential life lost.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
17

3. Injury Outcome by County of Accident Location for Bicyclists Involved in Accidents in

Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents by county for bicyclists involved in

crashes the injury outcome including the total involved, total injured, injury

rate per 100,000, total transported by EMS, total admitted to a hospital,

total with severe injury ISS>15, total charges, total with head/spinal

injuries, total deaths and total years of potential life lost. Data are reported

for 16 counties in Maine.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

4. Injury Outcome by Month of Accident for Bicyclists Involved in Accidents in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents for bicyclists involved in crashes the

injury outcome by month of crash for pedestrians including the total

involved, total injured, injury rate per 100,000, total transported by EMS,

total admitted to a hospital, total with severe injury ISS>15, total charges,

total with head/spinal injuries, total deaths and total years of potential life

lost.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
18

5. Injury Outcome by Day of Week of Accident for Bicyclists Involved in Accidents in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents by day of week for bicyclists involved in

crashes the injury outcome including the total involved, total injured, injury

rate per 100,000, total transported by EMS, total admitted to a hospital,

total with severe injury ISS>15, total charges, total with head/spinal

injuries, total deaths and total years of potential life lost.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

6. Injury Outcome by Time of Accident (1 hour intervals) for Bicyclists Involved in

Accidents in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents for bicyclists involved in crashes by time

of crash using one hour intervals the injury outcome including the total

involved, total injured, injury rate per 100,000, total transported by EMS,

total admitted to a hospital, total with severe injury ISS>15, total charges,

total with head/spinal injuries, total deaths and total years of potential life

lost.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
19

7. Injury Outcome for Bicyclists Involved in Alcohol-Related Accidents in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents injury outcome for bicyclists including

the total involved, total injured, total transported by EMS, total admitted to

a hospital, total with severe injury ISS>15, total charges, total with

head/spinal injuries, total deaths, total years of potential life lost, and

relative risk. Data are reported separately for alcohol involved and nonalcohol involved crashes.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

8. Injury Outcome for Bicyclists Involved in Motor Vehicle Crashes by Population Density

of Accident Location in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents for bicyclists involved in motor vehicle

crashes by population density of crash location, the injury outcome

including the total involved, total injured, total transported by EMS, total

admitted to a hospital, total with severe injury ISS>15, total charges, total

with head/spinal injuries, total deaths, total years of potential life lost, and

relative risk of injury. Crash location is defined as population per square

mile as follows: metro (>500), urban (101-500), Suburban (51-100), rural

(7-50), wilderness (<7), unknown.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
20

9. Injury Outcome for Bicyclists Involved in Crashes by Roadway Location of Accident in

Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents for bicyclists involved in crashes by

roadway location of the crash the total involved, total injured, percent of

total injured, total transported by EMS, total admitted to a hospital, total

with severe injury ISS>15, total charges, total with head/spinal injuries,

total deaths, years of potential life lost and the relative risk. Roadway

location is defined as straight road, curved, 3 legged intersection, 4 legged

intersection, 5 legged intersection, driveways, bridges, interchange, other,

missing/invalid.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

10. Injury Outcome for Bicyclists Involved in Motor Vehicle Crashes by Apparent

Contributing Factor in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents for bicyclists involved in motor vehicle

crashes by apparent contributing factor the total involved, total injured,

percent of total injured, total transported by EMS, total admitted to a

hospital, total with severe injury ISS>15, total charges, total with

head/spinal injuries, total deaths and years of potential life lost. Results are

shown separately for thirty different apparent contributing factors. 

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
21

3.1.4 By Geographic Location

1. Analysis of the Medical and Financial Outcomes of Crash Injuries Occurring in

Connecticut(in process)

Scope All persons involved in 1994-1995 crashes in Connecticut

Data Used Crash data linked to hospital discharge, ambulatory surgery, emergency

department, trauma registry, death certificate and census data.

Format Study

Description This study reports on the predictors for motor vehicle crashes and the

location of injuries in Connecticut, and describes the injured victims of

these crashes in terms of their severity scores and outcomes by final

disposition, financial cost, discharge diagnosis, average length of stay, total

hospital days, and mortality at 30, 60, and 90 days. 

Contact Person Angela S. Mattie TEL: 203-294-7224; FAX: 203-284-9318

2. Injury Outcome by County in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents by county in Maine, the 1990 census

population, the total occupants, number injured, injury rate per 100,000

population, total transported by EMS, total admitted to a hospital, total

with severe injury ISS>15, total charges, total with head/spinal injuries,

total deaths, and the years of potential life lost. Data are reported for the

16 counties in Maine.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
22

3. Injury Outcome by Hospital Service Area in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents by hospital service area in Maine, the

total occupants, total injured, injury rate per 100,000 population, total

transported by EMS, total admitted to a hospital, total with severe injury

ISS>15, total charges, total with head/spinal injuries, total deaths, and the

years of potential life lost. Data are reported for 32 hospital service areas

within Maine.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

4. Injury Outcome by Population Density of Crash Location in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents by population density of the crash

location in Maine, the total occupants, total injured, percent of total

injuries, total transported by EMS, total admitted to a hospital, total with

severe injury ISS>15, total charges, total with head/spinal injuries, total

deaths, and the years of potential life lost and the relative risk. Crash

location is defined as population per square mile as follows: metro (>500),

urban (101-500), Suburban (51-100), rural (7-50), wilderness (<7),

unknown.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
23

3.1.5 By Date and Time

1. Injury Outcome by Month of Accident in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents by month for persons injured in motor

vehicle crashes the total occupants, total injured, total transported by

EMS, total admitted to a hospital, total with severe injury ISS>15, total

charges, total with head/spinal injuries, total deaths, and the years of

potential life lost. 

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

2. Injury Outcome by Day of Week of Accident in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents by day of week in Maine, the total

occupants, total injured, percent of total injures, total transported by EMS,

total admitted to a hospital, total with severe injury ISS>15, total charges,

total with head/spinal injuries, total deaths, and the years of potential life

lost. 

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
24

3. Injury Outcome by Time of Accident in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents by time of crash in Maine using one hour

intervals, the total occupants, total injured, percent of total injures, total

transported by EMS, total admitted to a hospital, total with severe injury

ISS>15, total charges, total with head/spinal injuries, total deaths, and the

years of potential life lost. 

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
25

3.1.6 By Type of Injury

1. Incidence and Cost of Traumatic Brain Injury in New Mexico (in process)

Scope All persons involved in 1995 crashes statewide in New Mexico

Data Used Crash linked to trauma registry, hospital discharge, Medicaid, and statewide

coroner’s data

Format Study

Description This study reports on the incidence and cost motor vehicle and non-motor

vehicle related causes of Traumatic Brain Injury. Linked data will be used

to identify TBI cases that are unique to each data file and those that appear

in more than one data file. The study population is described in terms of

age, gender, ethnicity, geographic distribution, external cause, extent of

hospitalization, length of coma, involved alcohol, work related, payer

source(s), and costs.

Contact Person Stuart Castle TEL 505-827-1435; FAX: 505-827-0013

2. Variations in Incidence and Cost for Lower Extremity Injuries in Wisconsin (in process)

Scope All persons involved in 1990-1994 motor vehicle crashes statewide in

Wisconsin

Data Used Crash data linked to hospital discharge and Medicaid data.

Format Study

Description This study reports incidence variations and cost of serious lower extremity

injuries from crashes during 1990-1994. Driver age, gender, occupant

seating position, use of restraints (including air bag), crash configuration,

estimated speed of crash, vehicle type, weight, and other characteristics will

be evaluated as potential factors for affecting severity and type of injury. 

Who pays will be identified in addition to the distribution of public and

private payer sources. Analyses use restraint as reported or as likely based

on independent field observation. Serious lower extremity injury are

defined as ICD-9-CM 821.00-829.99, 836.00-838.99, 928.00-928.99,

895.00-897.99. Abrasions, contusions and lacerations, strains and sprains

are excluded. Costs include hospital charges, estimates for rehabilitation

time and treatment for lower extremity injuries, plus Medicaid histories to

determine first year physical therapy and other outpatient costs.

Contact Person Martha Florey TEL: 608-266-3557; FAX: 608-267-0441
26

3.2 Occurrence of Health Care Costs

3.2.1 Costs and Safety Belt Use

1. Focus...Injuries and Costs Associated with Failure to Use Seat Belts in Missouri

Mark Van Tuinen

Scope All drivers involved in 1990 motor vehicle crashes statewide in Missouri

Data Used Crash linked to EMS, emergency department, hospital and insurance

claims data

Format Study

Description This report presents Missouri specific results of the effectiveness of safety

belts on injuries and costs.

Contact Person Mark Van Tuinen TEL: 573-751-6274; FAX: 573-526-4102

3.2.2 Who Pays?

1. Who Incurs and Pays for Hospital Care for Motor Vehicle Accident Victims in

Pennsylvania?(in process)

Scope All persons involved in 1994 motor vehicle crashes statewide in

Pennsylvania

Data Used Crash linked to EMS and hospital discharge data

Format Study

Description This study focuses on the financial implications of driver behavior related to

safety belt or air bag use on Medicaid, Medicare expenditures, and

insurance premiums for vehicle and health insurance, and Worker’s

compensation. Characteristics of groups of individuals and vehicles which

are associated with high and low hospital costs and who pays for these

costs are identified. Expected payor source is obtained from the hospital

discharge data.

Contact Person Hank Weiss TEL: 412-647-1117; FAX: 412-647-1111
27

3.2.3 Medicaid and Costs

1. The Cost of Motor Vehicle Crash Injuries to the Wisconsin Medicaid Program

Trudy A. Karlson, Martha D. Sumi, Daniel Wickeham, Charles Quade, and Sara Karon

Scope All persons involved in 1991 motor vehicle crashes statewide in Wisconsin. 

Data Used Crash linked to Medicaid data

Format Study

Description The study describes an algorithm developed to identify the crash-related

health care specifically provided by physician, hospital, long term care, and

other services to Medicaid beneficiaries. It identifies the cost of this care

for beneficiaries who were occupants, pedestrians, or motorcyclists. Costs

were identified for (1) individuals who were Medicaid-eligible prior to the

crash, and (2) individuals who became eligible immediately following the

crash as a result of severe injuries requiring expensive care. Costs for those

who became eligible two or three years after the crash when the payments

from their liability settlements finally ran out were not included. Alcohol

and safety belt use were considered in relation to the costs.

Contact Person Martha Florey TEL: 608-266-3557; FAX: 608-267-0441
28

3.2.4 Comparing Hospital Costs

1. Computing Hospital Costs Savings Using the Entire Crash Population Rather than Only

Hospitalized Cases in Utah

J. Michael Dean 

Scope All persons involved in 1991 motor vehicle crashes statewide in Utah

Data Used Crash linked to EMS, emergency department and hospital data

Format Study

Description This study describes models to compute hospital costs using the entire

crash population. Non-hospitalized occupants were assigned a charge of

$0 when the potential cost savings for belt use by the entire crash

population was calculated.

Contact Person Pat Nechodom TEL: 801-581-6410; FAX: 801-581-8686
29

4.0 APPLICATIONS FOR TRAFFIC SAFETY

4.1 Crash Characteristics

1. Injury Outcome by Posted Speed Limit in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by posted speed limit in Maine, using 5

mile intervals 25-65, unknown/missing, invalid, the total occupants, total

injured, percent of total injures, total transported by EMS, total admitted to

a hospital, total with severe injury ISS>15, total charges, total with

head/spinal injuries, total deaths, years of potential life lost and the relative

risk.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

2. Injury Outcome by Accident Type in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents by crash type the total occupants, total

injured, percent of total injures, total transported by EMS, total admitted to

a hospital, total with severe injury ISS>15, total charges, total with

head/spinal injuries, total deaths, years of potential life lost and the relative

risk. Crash type is defined to include object in road, rear end/side swipe,

head on/sideswipe, intersection movement, pedestrians, train, ran off road,

animal, bike, rollover, fire, submersion, rock thrown, jack knife,

missing/invalid, other.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
30

3. Injury Outcome by Roadway Location of Accident in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by roadway location of the crash the

total occupants, total injured, percent of total injured, total transported by

EMS, total admitted to a hospital, total with severe injury ISS>15, total

charges, total with head/spinal injuries, total deaths, years of potential life

lost and the relative risk. Location of crash is defined as straight road,

curved, 3 legged intersection, 4 legged intersection, 5 legged intersection,

driveways, bridges, interchange, other, missing/invalid.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

4. Injury Outcome by Light Conditions of Accident in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by light condition of the crash the total

occupants, total injured, percent of total injured, total transported by EMS,

total admitted to a hospital, total with severe injury ISS>15, total charges,

total with head/spinal injuries, total deaths, years of potential life lost and

the relative risk. Light conditions are defined as dawn (morning), daylight,

dusk (evening), dark (street lights on), dark (no street lights), dark (street

lights off), other, missing/invalid.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
31

5. Injury Outcome by Road Surface of Accident in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by road surface of the crash the total

occupants, total injured, percent of total injured, total transported by EMS,

total admitted to a hospital, total with severe injury ISS>15, total charges,

total with head/spinal injuries, total deaths, years of potential life lost and

the relative risk. Road surface is defined as dry, wet, snow/slush sanded,

snow slush not sanded, ice packed snow sanded, ice packed snow not

sanded, muddy, debris, oily, other, missing/invalid.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

6. Injury Outcome by Type of Road Work at Accident in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by type of road work at the crash the

total occupants, total injured, percent of total injured, total transported by

EMS, total admitted to a hospital, total with severe injury ISS>15, total

charges, total with head/spinal injuries, total deaths and years of potential

life lost. Road work is defined as none, construction zone, maintenance

area, utility work area, missing/invalid/other.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
32

7. Injury Outcome by Apparent Contributing Factors in Single Vehicle Crashes in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by apparent contributing factor in single

vehicle crashes, the total occupants, total injured, percent of total injured,

total transported by EMS, total admitted to a hospital, total with severe

injury ISS>15, total charges, total with head/spinal injuries, total deaths and

years of potential life lost. Results are shown separately for thirty different

apparent contributing factors. 

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

8. Injury Outcome by Apparent Contributing Factors in Multiple Vehicle Crashes in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by apparent contributing factor in

multiple vehicle crashes, the total occupants, total injured, percent of total

injured, total transported by EMS, total admitted to a hospital, total with

severe injury ISS>15, total charges, total with head/spinal injuries, total

deaths and years of potential life lost. Results are shown separately for

thirty different apparent contributing factors. 

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
33

9. Crash Parameters and Cost of Care in New York ( in process)

Scope All persons involved in 1992 motor vehicle crashes statewide in New York

Data Used Crash linked to EMS, emergency department, hospital and insurance

claims data

Format Study

Description Models were constructed to predict case level cost using the maximum

abbreviated injury scale (MAIS) or the Injury Severity Score (ISS) for

translation to injury severity, body region, and average cost. Transfers,

extraordinary treatment cases, or other outliers also were considered. 

Average and total charges were calculated for both models to determine the

impact of the different methodologies.

Contact Person Richard Guerin TEL: 518-474-2219; FAX: 518-486-6216
34

4.2 Vehicle Characteristics

1. Injury Outcome by Vehicle Type in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report

Description This management report presents by vehicle type, the total occupants,

number injured, percent of total injuries, total transported by EMS, total

admitted to a hospital, total with severe injury ISS>15, total charges, total

with head/spinal injuries, total deaths, years of potential life lost, and the

relative risk. Vehicle type defined as an occupant of car/light truck,

motorcycle rider, pedestrian, bicyclist, bus, commercial truck and

other/unknown. 

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

2. Injury Outcome by Type of Emergency Vehicle Involved in Accident in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by type of emergency vehicle involved at

the crash the total occupants, total injured, percent of total injured, total

transported by EMS, total admitted to a hospital, total with severe injury

ISS>15, total charges, total with head/spinal injuries, total deaths and years

of potential life lost. Emergency vehicle involved is defined as no, police

vehicle, ambulance, fire department, wrecker (enroute), other,

missing/invalid.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
35

3. Assessing Crash Severity through Vehicle Damage, Point of Damage on Vehicle, Number

of Vehicles in Crash, Posted Speed and Impact Speed in Utah

J. Michael Dean

Scope All persons involved in 1991 motor vehicle crashes in Utah

Data Used Crash linked to EMS, emergency department and hospital data

Format Study

Description This study compared several measures as surrogates for crash severity,

including “totaled” or “not totaled.” 

Contact Person Pat Nechodom TEL: 801-581-6410; FAX: 801-581-8686
36

4.3 Person Characteristics

4.3.1 Safety Belts

1. Report to Congress on Benefits of Safety Belts and Motorcycle Helmets, Based on Data

from the Crash Outcome Data Evaluation System (CODES)

National Highway Traffic Safety Administration (1996).

Scope All occupants of police reported crashes statewide for 1990, 1991, or 1992

in Hawaii, Maine, Missouri, New York, Pennsylvania, Utah, Wisconsin

Data Used Statewide crash linked to EMS, hospital, and other state data by seven

states and the state results statistically combined by NHTSA

Format Study

Description Occupant-specific, population-based outcome information used to evaluate

the effectiveness of safety belts and motorcycle helmets in terms of

mortality, morbidity, severity, and cost.

Contact Person Dennis Utter, NHTSA TEL: 202-366-5351, FAX: 202-366-7078

2. NHTSA Technical Report: The Crash Outcome Evaluation System (CODES)

Johnson, Sandra W. and Walker, Jonathan 

Scope All occupants of police reported crashes statewide for 1990, 1991, or 1992

in Hawaii, Maine, Missouri, New York, Pennsylvania, Utah, Wisconsin 

Data Used Statewide crash linked to EMS, hospital, and other state data by seven

states and the state results statistically combined by NHTSA

Format Study

Description Includes technical information about the probabilistic linkage and state

specific results as background reference for the Report to Congress on the

Benefits of Safety Belts and Motorcycle Helmets.

Contact Person Sandra Johnson, NHTSA TEL: 202-366-5364, FAX: 202-366-7078
37

3. Safety Belts and Head and Spinal Injuries in Maine

Karl Finison, Christiana Cook, Gary Menchen, and Douglas Thompson

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Study

Description This study measured the effectiveness of safety belts to reduce the risk for

head and spinal injuries using three outcome measures: reported by police,

reported by EMS, or reported by hospital. Study populations included

occupants of cars and light trucks.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

4. Within Vehicle Analysis of the Effectiveness of Seat Belts in Maine

Douglas Thompson

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Study

Description This within-vehicle analysis used conditional logistic regression to

determine whether alternative analytic techniques led to similar conclusions

as those prepared using NHTSA’s mandated CODES model. This type of

analysis provided more control for the circumstances and severity of the

crash than is possible based on measured variables, and generates estimates

that may be more poolable across states than estimates based on standard

unconditional logistic regression. 

Contact Person Douglas Thompson TEL: 207-780-4682 FAX 207-780-4953
38

5. Application of Ordered Logistic Regression to Evaluate the Efficacy of Seat Belts and

Helmets for Prevention of Injury in Maine

Christiana Cook

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Study

Description An ordered logistic regression model was used to obtain greater power to

reject the null hypothesis (belts or helmets are not effective) when it is false

than that provided by the NHTSA mandated model. Results indicate that

the new model was better for the helmet analysis but not the safety belt

analysis.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

6. Injury Outcome by Seating Position in Cars and Light Trucks Only Involved in Accidents

in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by seating position in cars and light

trucks only involved in the crash the total occupants, total injured, percent

of total injured, total transported by EMS, total admitted to a hospital, total

with severe injury ISS>15, total charges, total with head/spinal injuries,

total deaths, years of potential life lost and the relative risk. Seating

position is defined as driver, front seat passenger, rear seat passenger,

trunk/back of truck, hanging on, missing/unknown/invalid.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
39

7. Injury Outcome by Number of People in Cars and Light Trucks Involved in Accidents in

Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by number of people in cars and light

trucks involved in the crash the total occupants, total injured, percent of

total injured, total transported by EMS, total admitted to a hospital, total

with severe injury ISS>15, total charges, total with head/spinal injuries,

total deaths, years of potential life lost and the relative risk. Number of

people in crash and light trucks is defined as 1 occupant, 2 occupants, 3

occupants, 4 occupants, 5+ occupants, unknown/not in vehicle.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

8. Total Occupants, and Number and Percent Injured By Type of Ejection in Accident in

Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents the total occupants and the number and

percent injured by type of ejection in crashes in Maine. Ejection levels are

defined as not ejected, partially ejected, ejected, trapped-extricated,

other/missing.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
40

9. Unsafe Driving Behaviors and Hospitalization in Missouri.

Mark Van Tuinen

Scope All drivers involved in 1990 motor vehicle and motorcycle crashes

statewide in Missouri

Data Used Crash linked to EMS, emergency department, hospital and insurance

claims data

Format Study

Description This study presents Missouri specific results about the effectiveness of

safety belts and motorcycle helmets on reducing the need for

hospitalization as the result of a motor vehicle crash.

Contact Person Mark Van Tuinen TEL: 573-751-6274; FAX: 573-526-4102
41

4.3.2 Air Bags

1. Air Bag Effectiveness in Pennsylvania (in process)

Scope All persons involved in 1994 crashes statewide in Pennsylvania

Data Used Crash linked to EMS and hospital discharge data statewide

Format Study

Description This study reports on the effectiveness of air bags in reducing total and

average hospital costs, mortality, and morbidity from motor vehicle crashes. 

Air bag effectiveness is evaluated alone and in combination with safety belts

for various types of demographic, crash, and injury characteristics.

Contact Person Hank Weiss TEL: 412-647-1117; FAX: 412-647-1111
42

4.3.3 Helmet Utilization

1. Head Injuries Associated with Motorcycle Use in Wisconsin

Trudy Karlson and Charles Quade

Scope All riders involved in 1991 motorcycle crashes statewide

Data Used Crash linked to hospital data

Format Study

Description This study uses linked crash and hospital data to evaluate the effect of

motorcycle helmet use on specific brain injuries. Brain injuries were

defined from ICD-9-CM codes to include all cases indicating intracranial

injury. 

Contact Person Martha Florey TEL: 608-266-3557; FAX: 608-267-0441

2. Injuries and Costs Associated with Failure to Use Motorcycle Helmets in Missouri

 Mark Van Tuinen

Scope All riders involved in 1990 motorcycle crashes statewide in Missouri

Data Used Crash linked to EMS, emergency department, hospital and insurance

claims data

Format Study

Description This study presents Missouri specific results of the effectiveness of

motorcycle helmets on injuries and costs.

Contact Person Mark Van Tuinen TEL: 573-751-6274; FAX: 573-526-4102
43

4.3.4 Alcohol and Drug Use

1. Injury Outcome in Alcohol-Related Accidents in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents the injury outcome for alcohol and nonalcohol related crashes including the total occupants, total injured, total

transported by EMS, total admitted to a hospital, total with severe injury

ISS>15, total charges, total with head/spinal injuries, total deaths, total

years of potential life lost, and relative risk of injury.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

2. Injury Outcome for Pedestrians/Bicyclists Involved in Alcohol Related Crashes by

Apparent Physical Condition of Driver in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents for pedestrians/bicyclists involved in

alcohol related crashes by apparent physical condition of the driver the

injury outcome including the total involved, total injured, percent of total

injured, total transported by EMS, total admitted to a hospital, total with

severe injury ISS>15, total charges, total with head/spinal injuries, total

deaths and total years of potential life lost. Data are reported by apparent

physical condition of the driver. Apparent physical condition is defined as

normal, under the influence, had been drinking, had been using drugs,

asleep, fatigued, ill, handicapped, other, missing/invalid.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
44

3. Injury Outcome by Apparent Physical Condition of Driver in Single Vehicle Accidents in

Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents by apparent physical condition of the

driver in a single vehicle crash the injury outcome including the total

occupants, total injured, percent of total injured, total transported by EMS,

total admitted to a hospital, total with severe injury ISS>15, total charges,

total with head/spinal injuries, total deaths and total years of potential life

lost. Apparent physical condition is defined as normal, under the influence,

had been drinking, had been using drugs, asleep, fatigued, ill, handicapped,

other, missing/invalid.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
45

5.0 APPLICATIONS FOR HIGHWAY SAFETY

5.1 Roadway

5.1.1 Objects in Roadway

1. Evaluation of Severity and Outcome of Injury by Type of Object Struck in Connecticut (in

process)

Scope All persons involved in 1994-1995 crashes statewide in Connecticut

Data Used Crash data linked to hospital discharge, ambulatory surgery, emergency

department, trauma registry, death certificate and census data

Format Study

Description This study identifies discharge diagnoses, injury severity scores, location of

the crashes by type of object struck; outcomes for injured victims are

reported in terms of their final disposition, financial cost, discharge

diagnosis, average length of stay, total hospital days, and mortality at 30,

60, and 90 days.

Contact Person Angela S. Mattie TEL: 203-294-7224;FAX: 203-284-9318

2. Injury Outcome for Crashes Involving Moose, Deer or Other/Unknown in Maine

Karl Finison and Gary Menchen.

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and Department of Inland and Fisheries and

Wildlife data

Format Management Report 

Description This management report indicates for persons in crashes involving an

animal total occupants involved in the crash, total injured, total transported

by EMS, total admitted to a hospital, percent of the total injured, and the

average hospital charge. Animal type was defined as moose, deer, and

other.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086
46

3. Collisions With Utility Poles, Guide rails, and Median Barriers in New York (in process)

Scope All persons involved in 1994 motor vehicle crashes statewide in New York

Data Used CODES linked data; Utility industry for costs of moving utility poles; New

York State DOT for costs of modifying or replacing Guide rails and median

barriers

Format Study

Description This study provides information about the consequences of collisions with

fixed objects including, medical outcome and health care costs by type of

object struck, demographic and roadway characteristics of this type of

crash, cost and payors for replacing or moving the fixed object.

Contact Person Richard Guerin TEL: 518-474-2219; FAX: 518-486-6216

4. Effectiveness of Guide Rails in Reducing Severity, Injury and Death in Single Vehicle

Fixed Object Collisions in Pennsylvania. (in process)

Scope All persons involved in 1994 single vehicle fixed object crashes on high

speed state and Federal highways statewide in Pennsylvania

Data Used Crash data used to define the fixed objects and crash circumstances;

Crash/EMS/Hospital data used to define injury severity; Hospital data to

define costs.

Format Study

Description This study focuses on the effectiveness of guide rails in reducing severity

and incidence of injury and mortality associated with single vehicle fixed

object crashes. The effectiveness of breakaway design in roadside

hardware will also be evaluated.

Contact Person Hank Weiss TEL: 412-647-1117 FAX: 412-647-1111 
47

6.0 APPLICATIONS FOR EMS

6.1 Occurrence of EMS Transports

1. EMS Response Times by Population Density in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1987 and 1991 motor vehicle crashes statewide in

Maine

Data Used Crash linked to EMS, hospital, and census data

Format Management Report 

Description This management report presents for specific EMS times (access,

response, destination, total) the total EMS transports related to motor

vehicle crashes, the average time by population density. Population density

per square mile is defined as metro (>500), urban (101-500), suburban (51-

100), rural (7-50), wilderness (<7). Data are reported for 1987 and 1991.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

2. Geographic Information System for Emergency Medical Services Analysis in Hawaii

Lawrence Nitz, Karl E. Kim, Donna Maiava

Scope All persons involved in 1990 motor vehicle crashes in Hawaii

Data Used Crash linked to EMS, emergency department, hospital and insurance

claims data

Format Study

Description Mapping and spatial data sources are described in the context of

applications to analysis of location characteristics of EMS runs. Analyses

of point, segment, and areal aspects of EMS calls for young drivers,

motorcyclists, victims of utility pole and bus/pedestrian crashes and cardiac

emergencies that have application to EMS and transportation policy

planning are presented.

Contact Person Karl Kim TEL: 808-956-7381; FAX: 808-956-6870

6.2 Injury Severity and EMS
48

1. Severity of Injury and Average on Scene time for EMS Transports Related to Motor

Vehicle Crashes in Maine

Karl Finison and Gary Menchen

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS, hospital and census data

Format Management Report 

Description This management report presents the severity of injury and average on

scene time by EMS capability level. Severity is defined using the revised

trauma score as <3.99, 4-6.99, 7-7.84. EMS capability level is defined as

paramedic, other ALS, BLS, unknown.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

2. CODES Victim Severity as Predicted by EMS Variables in Utah

J. Michael Dean

Scope All persons involved in 1991 motor vehicle crashes statewide in Utah

Data Used Crash linked to EMS, emergency department, hospital and insurance

claims data

Format Study

Description This study describes the relationship of safety belt use and need for specific

EMS treatments.

Contact Person Pat Nechodom TEL: 801-581-6410; FAX: 801-581-8686
49

7.0 APPLICATIONS RELATED TO THE QUALITY OF STATE DATA

7.1 Under-Reporting of Collisions

1. Estimate of Police Under-Reporting of Collisions in Hawaii

Karl Kim and Lawrence Nitz

Scope All persons involved in 1990 motor vehicle crashes in Hawaii

Data Used Crash linked to EMS , hospital and medical insurance claims data

Format Study

Description This study estimates the extent of police under reporting of collisions in

Hawaii. Persons involved in police reported crashes ($1000 property

damage or injury) were matched to health records for persons whose cause

of injury was flagged as a motor vehicle crash. Unreported crashes were

defined as those health records for the motor vehicle crash victims that did

not match to a crash record. Crash reports are more likely to be missing

when the injuries are minor, injury symptoms do not appear until later, the

victim leaves the scene before the police arrive, the police are never called,

the records are lost during processing, or inaccurate data prevented the

records from linking.

Contact Person Karl Kim TEL: 808-956-7381; FAX: 808-956-6870
50

7.2 Over-reporting of Belt Use

1. Comparative Reporting of Belt Use, Alcohol, and Type of Injury from Police, EMS, and

Hospital Discharge Abstract Reports in Maine

Karl Finison

Scope All persons involved in 1991 motor vehicle crashes statewide in Maine

Data Used Crash linked to EMS and hospital discharge data

Format Study

Description This study compared reported belt use between police and EMS records

and between police and hospital records. It discusses the impact of the

varying levels of specificity used by the police, EMS, and hospital records

to define injury. EMS and hospital records indicating head and spinal

trauma were compared to identify under-reporting of injuries. The results

reported reinforced the view that valid reporting of the injury outcome of

motor vehicle crashes can best be accomplished through the linkage of

crash to hospital discharge and other medical records.

Contact Person Karl Finison TEL: 207-623-2555; FAX: 207-622-7086

2. Variations in Reported Belt Use in Different State Data Files in Missouri

Mark Van Tuinen

Scope All persons involved in 1990 motor vehicle crashes statewide in Missouri

Data Used Crash linked to EMS, emergency department, hospital and insurance

claims data

Format Study

Description This study evaluated the advantages of using linked data to determine

variations in reported belt use as recorded on the linked crash, EMS, and

Head and Spinal Cord Injury/Trauma (HSCIT) files. Agreement rates were

compared between the linked crash and EMS and the linked crash and

HSCIT files. Average charges were studied to assess the affect of the

disagreements in the three files. 

Contact Person Mark Van Tuinen TEL: 573-751-6274; FAX: 573-526-4102
51

3. Over-Reporting and Measured Effectiveness of Seat Belts in Motor Vehicle Crashes in

Utah

J. Michael Dean

Scope All persons involved in 1991 motor vehicle crashes statewide in Utah

Data Used Crash linked to EMS and discharge summaries of medical records from

hospitals and clinics (includes outpatient, emergency department, inpatient,

and rehabilitation facilities)

Format Study

Description This study evaluates the effect of seat belt over-reporting (information

biased differential misclassification) on the odds ratio and confidence limits

relating seat belt use and injury. Independent observational studies from

the same time period were used to obtain corrected odds ratios to provide

more reasonable estimates of seat belt effectiveness. 

Contact Person Pat Nechodom TEL: 801-581-6410; FAX: 801-581-8686

4. Estimates of the Effects of Seat Belt Over-Reporting on Wisconsin Motor Vehicle Crash

Analyses in Wisconsin

Trudy A. Karlson, Wayne Bigelow, Daniel Wickeham, Charles A. Quade

Scope All persons involved in 1991 motor vehicle crashes statewide in Wisconsin

Data Used Crash linked to hospital data

Format Study

Description This study presents a methodology for adjusting reported belt use to

prevent an overestimate of belt effectiveness. Field observation data and

logit parameters for occupant, vehicle and site characteristics mapped into

variables in the crash data to calculate a probability of belt use for every

passenger vehicle occupant whose crash record contained sufficient vehicle,

site and occupant information. A new dichotomous variable was created to

assign occupants’ belt use according to a new algorithm. Information

obtained from a medical record review was also used to justify the new

algorithm.

Contact Person Martha Florey TEL: 608-266-3557; FAX: 608-267-0441
52

7.3 Errors in Financial Information

1. Linked hospital discharge and Head and Spinal Cord/Trauma Injury Data (HSCIT) to

Compare Hospital Charges in Missouri

Mark Van Tuinan

Scope All persons involved in 1990 motor vehicle crashes statewide in Missouri

Data Used Hospital linked to head and spinal cord trauma registry data

Format Study

Description This study identified variations in total charges reported by two different

data sources of victims injured in motor vehicle crashes. Records for

patients not included in both data sources were compared according to

emergency department discharge to the operating room and ICU units,

length of stay, total charges, discharge to skilled nursing facility and rehab

unit, fatality, superficial injuries, etc. The variations were evaluated to

explain differences in the average charge generated by each data source. 

Contact Person Mark Van Tuinen TEL: 573-751-6274; FAX: 573-526-4102

2. The Effects of Data Outliers and Errors in Hospital Charges on Conclusions Regarding

the Efficacy of Safety Belt Use in Missouri

Mark Van Tuinan

Scope All persons involved in 1990 motor vehicle crashes statewide in Missouri

Data Used Hospital linked to head and spinal cord trauma registry data

Format Study

Description This study evaluated the effects of data outliers and errors in hospital

charges on the analysis of the effectiveness of safety belts. The potential

that very high charges increase the variability of the data, making it harder

to test for differences in any effect is discussed and recommendations are

made. 

Contact Person Mark Van Tuinen TEL: 573-751-6274; FAX: 573-526-4102
53

7.4 Developing State Data

1. Developing Statewide Emergency Department Data in Pennsylvania

Harold B. Weiss

Scope 1991 Emergency Department Data

Data Used Stratified sample of emergency department billing records from hospitals in

Pennsylvania

Format Study

Description This study reports on the use of computerized ED patient registration,

billing and log systems integrated systems using the UB-92 uniform billing

format to create a statewide emergency department data base. It discusses

the permanent storage of data in a computer-retrievable format, the

inclusion of diagnostic and treatment information, and the likelihood for

standardization of patient data for later merging at the state level.

Contact Person Hank Weiss TEL: 412-647-1117; FAX: 412-647-1111
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8.0 APPLICATIONS RELATED TO THE LINKED STATE DATA

8.1 Validating the Linkage

1. Identifying Records That Should Have Linked but Did Not, and Comparing Them to

Records That Did Link in Missouri

Mark Van Tuinan

Scope All persons involved in 1990 motor vehicle crashes statewide in Missouri

Data Used Crash linked to EMS, emergency department, hospital and insurance

claims data

Format Study

Description This study compared records that should have linked but did not and

records that did link using the presence of linkage identifiers and the linkage

methodology. The impact of the addition of the unlinked records was

evaluated by comparing average charges and admission rates.

Contact Person Mark Van Tuinen TEL: 573-751-6274; FAX: 573-526-4102

2. Comparing Linkage Methods: Ad Hoc Linkage Versus Probabilistic Linkage in Missouri

Mark Van Tuinan

Scope All persons involved in 1990 motor vehicle crashes statewide in Missouri

Data Used Crash linked to EMS, emergency department, hospital and insurance

claims data

Format Study

Description This study compares the linkage of HSCI (Head and Spinal Cord Injury)

and HD (Hospital Discharge) records using an Ad Hoc or Probabilistic

Linkage method. The impact of the different linkage methods was

evaluated using severity and the effectiveness of safety belts and helmets.

Contact Person Mark Van Tuinen TEL: 573-751-6274; FAX: 573-526-4102
55

3. Comparison of Two Hospital Data Files Using the Capture-recapture Formula in

Missouri

Mark Van Tuinan 

Scope All persons involved in 1990 motor vehicle crashes statewide in Missouri

Data Used Crash linked to EMS, emergency department, hospital and insurance

claims data

Format Study

Description To correct for suspected under-reporting, the State Hospital Discharge File

(HD) was compared to its Head and Spinal Cord Injury File (HSCI) using

probabilistic linkage. Missing data rates were calculated for each file and

each file was updated accordingly. 

Contact Person Mark Van Tuinen TEL: 573-751-6274; FAX: 573-526-4102
56

DOT HS 808 581

NRD-31

4/97