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APHA Scientific Session and Event Listing

Recorded presentation

James N. Laditka, DA, PhD, MPA¹, Ernest McCutcheon, MD, MPH², Lou-Ann Carter, MS³, Georgette Demian, MPH³, and Victor Coronado, MD, MPH⁴. (1) Department of Epidemiology and Biostatistics, University of South Carolina, 800 Sumter St., Arnold School of Public Health, Columbia, SC 29208, (803)777-6852, jladitka@gwm.sc.edu, (2) Department of Family and Preventive Medicine, USC School of Medicine, University of South Carolina, 128 Pond Ridge Road, Columbia, SC 29223, (3) Division of Injury and Violence Prevention, South Carolina Department of Health and Environmental Control, 1751 Calhoun St., Columbia, SC 29201, (4) Division of Injury Response, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, MS-F41, Atlanta, GA 30341-3724

At least 75 percent of all brain injuries are Mild Traumatic Brain Injury (MTBI). MTBI can produce serious long-term disabilities, costing $17 billion annually. We evaluated accuracy of MTBI case ascertainment using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes proposed by the Centers for Disease Control and Prevention (CDC) for use with statewide Emergency Department (ED) and Hospital Discharge (HD) data, comparing results from this approach with cases identified using evidence of clinical signs/symptoms and diagnostic procedures in the medical record. Trained abstractors reviewed 1,767 ED and 948 HD records identified as MTBI or severe traumatic brain injury (STBI) from Q3-Q4 of 2003. Percent inter-rater agreement for MTBI+STBI was 89.8, with kappa=0.53. Data were insufficient to establish TBI severity in 38.5% of ED records, 11.0% of HD. Predictive Value Positive for ED was 96.8 for MTBI, 26.1 for STBI; PVP for HD was 56.7 for MTBI, 58.4 for STBI. In the 959.01 category (unspecified head injury), only 52.6% met MTBI criteria. For records with Facial Bone Fracture codes (802), 47.0% of 325 ED cases and 59.5% of 79 HD cases contained uncoded MTBI/STBI criteria. Conclusions: (1). PVP for MTBI in ED was acceptable, questionable in HD; (2) code 959.01 may indicate head injury, but overestimates MTBI; (3) the 802 code group included a notable number of false negatives; (4) physicians need to improve recording of available diagnostic criteria but also need more specific diagnostic resources; (5) ICD-9-CM codes may be inadequate for identifying ED STBI.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Discuss the desirability of surveillance for mild traumatic brain injury.
• Assess the usefulness of ICD-9-CM codes from emergency departments (ED) and hospital discharge (HD) records for mild traumatic brain injury case ascertainment.
• Describe specific mechanisms that might improve the use of ED and HD records for mild traumatic brain injury surveillance.

Keywords: Traumatic Brain Injury, Surveillance

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation