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Injury. 2015 May;46(5):891-7. doi: 10.1016/j.injury.2014.11.012. Epub 2014 Nov 26.

Making the most of injury surveillance data: using narrative text to identify exposure information in case-control studies.

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College of Nursing, Washington State University, Spokane, WA, USA; Harborview Injury Prevention and Research Center (HIPRC), University of Washington, Seattle, WA, USA. Electronic address:
Department of Health Policy and Management, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, Alberta, Canada.
Harborview Injury Prevention and Research Center (HIPRC), University of Washington, Seattle, WA, USA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.



Free-text fields in injury surveillance databases can provide detailed information beyond routinely coded data. Additional data, such as exposures and covariates can be identified from narrative text and used to conduct case-control studies.


To illustrate this, we developed a text-search algorithm to identify helmet status (worn, not worn, use unknown) in the U.S. National Electronic Injury Surveillance System (NEISS) narratives for bicycling and other sports injuries from 2005 to 2011. We calculated adjusted odds ratios (ORs) for head injury associated with helmet use, with non-head injuries representing controls. For bicycling, we validated ORs against published estimates. ORs were calculated for other sports and we examined factors associated with helmet reporting.


Of 105,614 bicycling injury narratives reviewed, 14.1% contained sufficient helmet information for use in the case-control study. The adjusted ORs for head injuries associated with helmet-wearing were smaller than, but directionally consistent, with previously published estimates (e.g., 1999 Cochrane Review). ORs illustrated a protective effect of helmets for other sports as well (less than 1).


This exploratory analysis illustrates the potential utility of relatively simple text-search algorithms to identify additional variables in surveillance data. Limitations of this study include possible selection bias and the inability to identify individuals with multiple injuries. A similar approach can be applied to study other injuries, conditions, risks, or protective factors. This approach may serve as an efficient method to extend the utility of injury surveillance data to conduct epidemiological research.


Case-control study; Epidemiology; Head injuries; Helmet; Narrative text; Recreation/sports

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