Abstract
BackgroundThe case definition for traumatic brain injury (TBI) often includes ‘unspecified injury to the head’ diagnostic codes. However, research has shown that the inclusion of these codes leads to false positives. As such, it is important to determine the degree to which inclusion of these codes affect the overall numbers and profiles of the TBI population. The objective of this paper was to profile and compare the demographic and clinical characteristics, intention and mechanism of injury, and discharge disposition of hospitalized children and youth aged 19 years and under using (1) an inclusive TBI case definition that included ‘unspecified injury to the head’ diagnostic codes, (2) a restricted TBI case definition that excluded ‘unspecified injury to the head ‘diagnostic codes, and (3) the ‘unspecified injury to the head’ only case definition.MethodsThe National Ambulatory Care Reporting System and the Discharge Database from Ontario, Canada, were used to identify cases between fiscal years 2003/04 and 2009/10.ResultsThe rate of TBI episodes of care using the inclusive case definition for TBI (2,667.2 per 100,000) was 1.65 times higher than that of the restricted case definition (1,613.3 per 100,000). ‘Unspecified injury to the head’ diagnostic codes made up of 39.5 % of all cases identified with the inclusive case definition. Exclusion of ‘unspecified injury to the head’ diagnostic code in the TBI case definition resulted in a significantly higher proportion of patients in the intensive care units (p < .0001; 18.5 % vs. 22.2 %) and discharged to a non-home setting (p < .0001; 9.9 % vs. 11.6 %).ConclusionInclusion of ‘unspecified injury to the head’ diagnostic codes resulted in significant changes in numbers, healthcare use, and causes of TBI. Careful consideration of the inclusion of ‘unspecified injury to the head’ diagnostic codes in the case definition of TBI for the children and youth population is important, as it has implications for the numbers used for policy, resource allocation, prevention, and planning of healthcare services. This paper can inform future work on reaching consensus on the diagnostic codes for defining TBI in children and youth.
Highlights
The case definition for traumatic brain injury (TBI) often includes ‘unspecified injury to the head’ diagnostic codes
Data source Cases in the emergency department (ED) and acute care were identified in the Canadian Institute for Health Information (CIHI) National Ambulatory Care Reporting System (NACRS) and Discharge Abstract Database (DAD) by the presence of an International Classification of Diseases (ICD)-10 diagnostic code for TBI
TBI episodes of care Between fiscal years 2003/04 and 2009/10, the rate of TBI episodes of care identified by the inclusive case definition (2,667.2 per 100,000) was 1.65 times higher than the rate of TBI identified by the restricted case definition (1,613.3 per 100,000)
Summary
The case definition for traumatic brain injury (TBI) often includes ‘unspecified injury to the head’ diagnostic codes. The objective of this paper was to profile and compare the demographic and clinical characteristics, intention and mechanism of injury, and discharge disposition of hospitalized children and youth aged 19 years and under using (1) an inclusive TBI case definition that included ‘unspecified injury to the head’ diagnostic codes, (2) a restricted TBI case definition that excluded ‘unspecified injury to the head ‘diagnostic codes, and (3) the ‘unspecified injury to the head’ only case definition. Traumatic brain injury (TBI) is “an insult to the brain that affects its structure or function, resulting in impairments of cognition, communication, physical function, or psychosocial behavior”. It includes “open head injuries (e.g., gun shot wound other penetrating injuries) or closed head injuries (e.g., blunt trauma, acceleration/ deceleration injury, blast injury)” [1]. The current lack of consensus on the case definition for TBI and the validity of various diagnostic codes make it difficult to accurately and appropriately capture information on pediatric TBI that can be used for planning and resource allocation
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