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APHA Scientific Session and Event Listing

Limor Aharonson-Daniel, PhD, Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel, 972-3-5354252, limorad@gertner.health.gov.il

Background: The CDC clinical case definition of Traumatic Brain Injury (TBI) encompasses a wide range of conditions with large variability in severity and outcome. This study uses aggregated data to suggest a division of TBI into categories that would reduce variance within the definition and encourage uniformity. Aims: To propose a parting of TBI definition into levels, to discuss alternative groupings and the subsequent implications for TBI public health issues. Methods: Retrospective analysis of TBI data recorded in the Israel National Trauma Registry 1/1/1998-12/31/2004. ICD-9-CM diagnoses were grouped based on recorded evidence of intracranial injury, the occurrence/duration of unconsciousness etc. Patients were included only if they had an isolated injury, to ensure that the source of severity is not another injury in the same patient. Injury, hospitalization and outcome characteristics of these groups were compared. Results: 17701 patients met the inclusion criteria. 6135 (34.7%) had level 1, 10319 (58.3%) level 2, and 1247 (7%) level 3 TBI. Age was significantly higher in the level 1 group with a median of 27 (iqr 7-68) years, 6 (2-19) years in the level 2 TBI and 2 (0-5) years for level 3 TBI patients. Critical injuries (ISS>25) were more common in level 1 TBI: 14.8% vs 0.1% in level 2 and 0.0% in level 3. Inpatient mortality was 9.2% in level 1, 0.1% in level 2 and no patients died in the third group of TBI. Various analyses suggest that the assignment of diagnoses to levels 2 & 3 needs to be refined.

Learning Objectives:

• By the end of this session the audience will be familiar with TBI definitions and the large scope of conditions they cover. Patient outcome data and clinical reasoning will demonstrate the rational for the sub-division of TBI definition into categories and the motivation to create more homogeneous categories among TBI injuries. The audience will learn that levels are characterized by different proportions of severe injuries, outcomes, hospital resource use, injury mechanisms and age distribution, thus validating the classification. Furthermore, the implications of changing a definition on public health will be discussed.

Keywords: Traumatic Brain Injury,

Presenting author's disclosure statement:

Any relevant financial relationships? No