Abstract
Background: The initial injury burden from incident TBI is significantly amplified by recurrent TBI (rTBI). Unfortunately, research assessing the accuracy to conduct rTBI surveillance is not available. Accurate surveillance information on recurrent injuries is needed to justify the allocation of resources to rTBI prevention and to conduct high quality epidemiological research on interventions that mitigate this injury burden. This study evaluates the accuracy of administrative health data (AHD) surveillance case definitions for rTBI and estimates the 1-year rTBI incidence adjusted for measurement error.Methods: A 25% random sample of AHD for Montreal residents from 2000 to 2014 was used in this study. Four widely used TBI surveillance case definitions, based on the International Classification of Disease and on radiological exams of the head, were applied to ascertain suspected rTBI cases. Bayesian latent class models were used to estimate the accuracy of each case definition and the 1-year rTBI measurement-error-adjusted incidence without relying on a gold standard rTBI definition that does not exist, across children (<18 years), adults (18-64 years), and elderly (> =65 years).Results: The adjusted 1-year rTBI incidence was 4.48 (95% CrI 3.42, 6.20) per 100 person-years across all age groups, as opposed to a crude estimate of 8.03 (95% CrI 7.86, 8.21) per 100 person-years. Patients with higher severity index TBI had a significantly higher incidence of rTBI compared to patients with lower severity index TBI. The case definition that identified patients undergoing a radiological examination of the head in the context of any traumatic injury was the most sensitive across children [0.46 (95% CrI 0.33, 0.61)], adults [0.79 (95% CrI 0.64, 0.94)], and elderly [0.87 (95% CrI 0.78, 0.95)]. The most specific case definition was the discharge abstract database in children [0.99 (95% CrI 0.99, 1.00)], and emergency room visits claims in adults/elderly [0.99 (95% CrI 0.99, 0.99)]. Median time to rTBI was the shortest in adults (75 days) and the longest in children (120 days).Conclusion: Conducting accurate surveillance and valid epidemiological research for rTBI using AHD is feasible when measurement error is accounted for.
Highlights
The initial injury burden from incident Traumatic brain injury (TBI) is significantly amplified by recurrent TBI
This study evaluates the accuracy of administrative health data (AHD) surveillance case definitions for recurrent TBI (rTBI) and estimates the 1-year rTBI incidence adjusted for measurement error
The current analysis we are conducting on rTBI adjusts for measurement error for administrative health data to detect rTBI. This analysis carries over all the uncertainty from the initial analysis on incident TBI to the current analysis on rTBI, and simultaneously addresses measurement error in the diagnosis of both incident and recurrent TBI. Such an approach ensures that we provide valid parameter estimates that incorporate all of the uncertainty that exists around incident and rTBI diagnoses in administrative health data
Summary
The initial injury burden from incident TBI is significantly amplified by recurrent TBI (rTBI). Within a 1-year period after an index TBI, recurrent TBI (rTBI) affects 5-10% of individuals [9]. These recurrent injuries are associated with poorer outcomes, such as an increase in post-concussive symptoms leading to productivity losses and long-term complications such as suicide and Chronic Traumatic Encephalopathy [10,11,12,13,14,15]. Feasible and timely approaches to conducting public health surveillance of these recurrent injuries is primordial to understanding the TBI burden and assessing whether interventions destined to mitigate them are effective [1, 17]
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