Online Program

323208
Assessment of ICD-9-CM Codes included in the CDC's Definition of a Traumatic Brain Injury


Tuesday, November 3, 2015 : 1:10 p.m. - 1:25 p.m.

Juliet Haarbauer-Krupa, PhD, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
Shawn Hirsch, MPH, SciMetrika, LLC, Durham, NC
Victor Coronado, MD, MPH, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
Raydel Valdes, PhD, MPH, MS, SciMetrika, LLC, Durham, NC
Brooks Lowe, MPH, SciMetrika, LLC, Durham, NC
Johna Register-Mihalik, PhD, LAT, ATC, Department of Exercise and Sport Science/Emergency Services Institute, UNC-Chapel Hill/WakeMed Health & Hospitals, Chapel Hill, NC
Introduction:This study evaluated the sensitivity and specificity of CDC’s TBI ICD-9-CM code-based definition to detect TBI in a pediatric population.

Methods:We reviewed 200 pediatric medical records from patients who sustained a suspected TBI from April – September 2013 for “signs and symptoms” consistent with CDC’s TBI clinical definition (Marr et al 2002). Patients with a suspected head injury were randomly sampled from a system of Emergency Departments (EDs) (n = 150) and a concussion services clinic (n = 50). ICD-9-CM diagnosis data was obtained from each billing department. Sensitivity and specificity of ICD-9-CM codes to detect TBI was calculated.

Results:‘Head Injury, Unspecified’ was the most commonly reported (19%) ICD-9-CM code among sampled ED patients. ‘Intracranial Injury’ (37%) and ‘Lack of Coordination’ (37%) were the most commonly reported ICD-9-CM codes among sampled concussion services patients. Sensitivity (66%; 95% CI = 57%-74%) and specificity (63%; 95% CI = 51%-74%) of CDC’s definition was relatively low. Among charts with a single reported ICD-9-CM code, ‘Intracranial Injury’ had the highest positive predictive value (PPV) (100%) and ‘Head Injury, Unspecified’ had the lowest PPV (42%). Among charts with multiple codes, PPV was highest when a CDC TBI code and TBI sign/symptom code (89%) were present.

Conclusion:Sensitivity and specificity of CDC’s TBI definition could be improved if TBI sign/symptom codes are included when in conjunction with other TBI-related codes.  Further research is needed to determine if combinations of ICD-9-CM codes would increase the sensitivity without negatively impacting specificity.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Epidemiology
Public health or related research

Learning Objectives:
Evaluate the sensitivity of CDC's TBI code-based definition to detect TBI in a pediatric population; List ICD-9-CM codes that may be considered for inclusion or exclusion from CDC's TBI code-based definition

Keyword(s): Traumatic Brain Injury, Pediatrics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Senior Health Scientist on the TBI team in the Division of Unintentional Injury at the CDC and principal author on the abstract. I have multiple publications on traumatic brain injury in the area of epidemilogy and outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.