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Traumatic Brain Injury Classification. Limor Aharonson-Daniel, PhD. For International Collaborative Effort on Injury Statistics, Washington DC, September 7-8, 2006. Israel national center for trauma and emergency medicine research

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Traumatic Brain Injury Classification


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slide1

Traumatic Brain Injury Classification

Limor Aharonson-Daniel, PhD

For

International Collaborative Effort on Injury Statistics,

Washington DC, September 7-8, 2006

Israel national center for trauma and emergency medicine research

Gertner Institute for Epidemiology and Health Policy Research

slide2

In 1995, clinical case definition standardized

  • It included any intracranial injury and any reported loss of consciousness or concussion.

Guidelines for Surveillance of Central Nervous System Injury Thurman DJ, Sniezek JE, Jonson D, Greenspan A, Smith SMAtlanta: Centers for disease Control and Prevention, 1995).

slide3

duration

< 1 hr

1-24 hr

24 hr+

unknown

yes

yes

no

LOC

Intracranial injury

no

concussion

Fracture

Internal

Nerves

ICD-9-CM

The definition encompasses a wide range of conditions which are easily, and with clinical reasoning, classifiable into two very distinctive groups of patients

slide4

Type 1 TBI: recorded evidence of an intracranial injury or a moderate or a prolonged loss of consciousness

Shaken Infant Syndrome and injuries to the optic nerve pathways.

Type 2 TBI: no recorded evidence of intracranial injury and a  loc of less than one hour, a loc of unknown duration or an unspecified level of consciousness. 

Type 3 TBI: no evidence of intracranial injury and no loc.

Barell matrix definitions

slide6
“We highly recommend the development of research guidelines to standardize definitional, case finding, and data reporting parameters to help establish a more precise description and hence utility of the epidemiology of TBI in Europe”.

It was difficult to reach a consensus on all epidemiological findings across the 23 published European studies because of critical differences in methods employed across the reports.

A systematic review of brain injury epidemiology in Europe

F. Tagliaferri, C. Compagnone, M. Korsic, F. Servadei, and J. Kraus

Acta Neurochir (Wien) (2005) Published online November 28, 2005

slide7

Langlois JA, Rutland-Brown W, Thomas KE. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2006.

The ICD-9-CM codes for TBI included in the analysis

differed slightly from those in the Barell Matrix, a recommended

categorization of ICD-9-CM codes for nonfatal injuries.

The inclusion of 959.01 (head injury, unspecified)…

slide8

ICD-9-CM codes for traumatic brain injury related ED visits (1995-2001)

Fracture of the vault or base of the skull 800.0–801.9

Other and unqualified multiple fractures of the skull 803.0–804.9

Intracranial injury, including concussion, contusion,

laceration, and hemorrhage 850.0–854.1

Head injury, unspecified 959.01

995.55, 950(.1-.3)

Langlois JA, Rutland-Brown W, Thomas KE. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2006.

slide9

Epidemiology of Emergency Department-Treated Traumatic Brain Injury in Minnesota

Day H, Roesler J, Gaichas A, Kinde M,

Accessed at http://www.mmaonline.net/Publications/MNMed2006/May/clinical-day.htm on aug 4 2006

slide10

Mild traumatic brain injury in the United States, 1998–2000

‘skull fracture’ (800.0, 800.5, 801.0, 801.5, 803.0, 803.5, 804.0, 804.5),

‘concussion’ (850.0, 850.1, 850.5, 850.9), ‘intracranial

injury of unspecified nature’ (854.0) and ‘head

injury, unspecified’ (959.0).

These codes are intended to identify TBI’s that approximate the mTBI clinical definition. They were recommended as the administrative case definition of mTBI for surveillance and research by the Centers for Disease Control and Prevention Mild Traumatic Brain Injury Work Group in October 2002.

Includes cases where there is no intracranial injury even if there

is an extended (>24h) LOC

BAZARIAN JJ, MCCLUNG J, SHAH MN, CHENG YT, FLESHER W & KRAUS J

Brain Injury, February 2005; 19(2): 85–91

slide11

A look at the data

Population and methods

Retrospective analysis of TBI data recorded in the Israel National Trauma Registry 1/1/1998-12/31/2005.

Patients were included if they had isolated TBI.

age distribution by type of tbi
AGE distribution by type of TBI

1998-2005, 7408 patients with isolated TBI

severity of injury iss
SEVERITY OF INJURY (ISS)

1998-2005, 7408 patients with isolated TBI

type of tbi by injury severity
Type of TBI by injury severity

Among ISS 16+

(n=3077)

Among all TBI

(n=7408)

severity indicators
Severity Indicators

1998-2005, 7408 patients with isolated TBI

slide16

Conclusion:

Groups seem valid.

Need to touch up definitions and finish the

work begun a decade ago

Implications for ICD-11?

slide17

Partners?

NCIPC

ANA

Do we agree that it is our business to improve and disseminate

a uniform / multi-leveled TBI definition?