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Biswas A, Mustard CA, Landsman V. Trends in severity of work-related traumatic injury and musculoskeletal disorder, Ontario 2004-2017. Am J Ind Med 2024; 67:646-656. [PMID: 38751170 DOI: 10.1002/ajim.23614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES Traumatic injury surveillance can be enhanced by describing injury severity trends. This study reports trends in work-related injury severity for males and females over the period 2004-2017 in Ontario, Canada. METHODS A weighted measure of workers' compensation benefit expenditures was used to define injury severity, obtained from the linkage of workers' compensation claims to emergency department (ED) records where the main injury or illness was attributed to work. Denominator counts were obtained from Statistics Canada's Labor Force Survey. Trends in the annual incidence of injury, classified as low, moderate, or high severity, were examined using regression modeling, stratified by age and sex. RESULTS Over a 14-year observation period, there were 1,636,866 ED records included in the analyses. Overall, 57.6% of occupational injury records were classified as low severity, 29.5% as moderate severity, and 12.8% as high severity conditions. There was an increase in the incidence of high severity injuries among females (annual percent change (APC): 1.52%; 95% CI: 0.77, 2.28), while the incidence of low and moderate severity injuries generally declined for males and females. Among females, injuries attributed to animate mechanical forces and assault increased as causes of low, moderate, and high severity injuries. The incidence of concussion increased for both males (APC: 10.51%; 95% CI: 8.18, 12.88) and females (APC: 16.37%; 95% CI: 13.37, 19.45). CONCLUSION The incidence of severe work-related injuries increased among females in Ontario between 2004 and 2017. The methods applied in this surveillance study of traumatic injury severity are plausibly generalizable to applications in other jurisdictions.
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Affiliation(s)
- Aviroop Biswas
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cameron A Mustard
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Landsman
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Daugherty J, Peterson A, Waltzman D, Breiding M, Chen J, Xu L, DePadilla L, Corrigan JD. Rationale for the Development of a Traumatic Brain Injury Case Definition for the Pilot National Concussion Surveillance System. J Head Trauma Rehabil 2024; 39:115-120. [PMID: 38039498 DOI: 10.1097/htr.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
BACKGROUND Current methods of traumatic brain injury (TBI) morbidity surveillance in the United States have primarily relied on hospital-based data sets. However, these methods undercount TBIs as they do not include TBIs seen in outpatient settings and those that are untreated and undiagnosed. A 2014 National Academy of Science Engineering and Medicine report recommended that the Centers for Disease Control and Prevention (CDC) establish and manage a national surveillance system to better describe the burden of sports- and recreation-related TBI, including concussion, among youth. Given the limitations of TBI surveillance in general, CDC took this recommendation as a call to action to formulate and implement a robust pilot National Concussion Surveillance System that could estimate the public health burden of concussion and TBI among Americans from all causes of brain injury. Because of the constraints of identifying TBI in clinical settings, an alternative surveillance approach is to collect TBI data via a self-report survey. Before such a survey was piloted, it was necessary for CDC to develop a case definition for self-reported TBI. OBJECTIVE This article outlines the rationale and process the CDC used to develop a tiered case definition for self-reported TBI to be used for surveillance purposes. CONCLUSION A tiered TBI case definition is proposed with tiers based on the type of sign/symptom(s) reported the number of symptoms reported, and the timing of symptom onset.
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Affiliation(s)
- Jill Daugherty
- Author Affiliations: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia (Drs Daugherty, Peterson, Waltzman, Breiding, Chen, Xu, and DePadilla); and Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus (Dr Corrigan)
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Daugherty J, Waltzman D, Breiding M, Peterson A, Chen J, Xu L, Womack LS, DePadilla L, Watson K, Corrigan JD. Refinement of a Preliminary Case Definition for Use in Traumatic Brain Injury Surveillance. J Head Trauma Rehabil 2024; 39:121-139. [PMID: 38039496 DOI: 10.1097/htr.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Current methods used to measure incidence of traumatic brain injury (TBI) underestimate its true public health burden. The use of self-report surveys may be an approach to improve these estimates. An important step in public health surveillance is to define a public health problem using a case definition. The purpose of this article is to outline the process that the Centers for Disease Control and Prevention undertook to refine a TBI case definition to be used in surveillance using a self-report survey. SETTING Survey. PARTICIPANTS A total of 10 030 adults participated via a random digit-dial telephone survey from September 2018 to September 2019. MAIN MEASURES Respondents were asked whether they had sustained a hit to the head in the preceding 12 months and whether they experienced a series of 12 signs and symptoms as a result of this injury. DESIGN Head injuries with 1 or more signs/symptoms reported were initially categorized into a 3-tiered TBI case definition (probable TBI, possible TBI, and delayed possible TBI), corresponding to the level of certainty that a TBI occurred. Placement in a tier was compared with a range of severity measures (whether medical evaluation was sought, time to symptom resolution, self-rated social and work functioning); case definition tiers were then modified in a stepwise fashion to maximize differences in severity between tiers. RESULTS There were statistically significant differences in the severity measure between cases in the probable and possible TBI tiers but not between other tiers. Timing of symptom onset did not meaningfully differentiate between cases on severity measures; therefore, the delayed possible tier was eliminated, resulting in 2 tiers: probable and possible TBI. CONCLUSION The 2-tiered TBI case definition that was derived from this analysis can be used in future surveillance efforts to differentiate cases by certainty and from noncases for the purpose of reporting TBI prevalence and incidence estimates. The refined case definition can help researchers increase the confidence they have in reporting survey respondents' self-reported TBIs as well as provide them with the flexibility to report an expansive (probable + possible TBI) or more conservative (probable TBI only) estimate of TBI prevalence.
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Affiliation(s)
- Jill Daugherty
- Author Affiliations: Division of Injury Prevention, Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Atlanta, Georgia (Drs Daugherty, Waltzman, Breiding, Peterson, Chen, Xu, Womack, and DePadilla); United States Public Health Service, Commissioned Corps, Washington, District of Columbia (Drs Breiding and Womack); Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention & Health Promotion, Division of Population Health, Atlanta, Georgia (Dr Watson); and Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus (Dr Corrigan)
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4
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Paleczny S, Osagie N, Sethi J. Validity and reliability International Classification of Diseases-10 codes for all forms of injury: A systematic review. PLoS One 2024; 19:e0298411. [PMID: 38421992 PMCID: PMC10903801 DOI: 10.1371/journal.pone.0298411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Intentional and unintentional injuries are a leading cause of death and disability globally. International Classification of Diseases (ICD), Tenth Revision (ICD-10) codes are used to classify injuries in administrative health data and are widely used for health care planning and delivery, research, and policy. However, a systematic review of their overall validity and reliability has not yet been done. OBJECTIVE To conduct a systematic review of the validity and reliability of external cause injury ICD-10 codes. METHODS MEDLINE, EMBASE, COCHRANE, and SCOPUS were searched (inception to April 2023) for validity and/or reliability studies of ICD-10 external cause injury codes in all countries for all ages. We examined all available data for external cause injuries and injuries related to specific body regions. Validity was defined by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Reliability was defined by inter-rater reliability (IRR), measured by Krippendorff's alpha, Cohen's Kappa, and/or Fleiss' kappa. RESULTS Twenty-seven published studies from 2006 to 2023 were included. Across all injuries, the mean outcome values and ranges were sensitivity: 61.6% (35.5%-96.0%), specificity: 91.6% (85.8%-100%), PPV: 74.9% (58.6%-96.5%), NPV: 80.2% (44.6%-94.4%), Cohen's kappa: 0.672 (0.480-0.928), Krippendorff's alpha: 0.453, and Fleiss' kappa: 0.630. Poisoning and hand and wrist injuries had higher mean sensitivity (84.4% and 96.0%, respectively), while self-harm and spinal cord injuries were lower (35.5% and 36.4%, respectively). Transport and pedestrian injuries and hand and wrist injuries had high PPVs (96.5% and 92.0%, respectively). Specificity and NPV were generally high, except for abuse (NPV 44.6%). CONCLUSIONS AND SIGNIFICANCE The validity and reliability of ICD-10 external cause injury codes vary based on the injury types coded and the outcomes examined, and overall, they only perform moderately well. Future work, potentially utilizing artificial intelligence, may improve the validity and reliability of ICD codes used to document injuries.
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Affiliation(s)
- Sarah Paleczny
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Nosakhare Osagie
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jai Sethi
- Injury Prevention Research Office, Division of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
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5
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Ledoux AA, Sicard V, Bijelić V, Barrowman N, Borghese MM, Kuzik N, Tremblay MS, Yeates KO, Davis AL, Sangha G, Reed N, Zemek RL. Optimal Volume of Moderate-to-Vigorous Physical Activity Postconcussion in Children and Adolescents. JAMA Netw Open 2024; 7:e2356458. [PMID: 38363567 PMCID: PMC10873766 DOI: 10.1001/jamanetworkopen.2023.56458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024] Open
Abstract
Importance Determining the optimal volume of early moderate-to-vigorous-intensity physical activity (MVPA) after concussion and its association with subsequent symptom burden is important for early postinjury management recommendations. Objectives To investigate the association between cumulative MVPA (cMVPA) over 2 weeks and subsequent symptom burden at 1 week, 2 weeks, and 4 weeks postinjury in children and examine the association between cMVPA and odds of persisting symptoms after concussion (PSAC) at 2 weeks and 4 weeks postinjury. Design, Setting, and Participants This multicenter cohort study used data from a randomized clinical trial that was conducted from March 2017 to December 2019 at 3 Canadian pediatric emergency departments in participants aged 10.00 to 17.99 years with acute concussion of less than 48 hours. Data were analyzed from July 2022 to December 2023. Exposure cMVPA postinjury was measured with accelerometers worn on the waist for 24 hours per day for 13 days postinjury, with measurements deemed valid if participants had 4 or more days of accelerometer data and 3 or fewer consecutive days of missing data. cMVPA at 1 week and 2 weeks postinjury was defined as cMVPA for 7 days and 13 days postinjury, respectively. Multiple imputations were carried out on missing MVPA days. Main Outcomes and measures Self-reported postconcussion symptom burden at 1 week, 2 weeks, and 4 weeks postinjury using the Health and Behavior Inventory (HBI). PSAC was defined as reliable change on the HBI. A linear mixed-effect model was used for symptom burden at 1 week, 2 weeks, and 4 weeks postinjury with a time × cMVPA interaction. Logistic regressions assessed the association between cMVPA and PSAC. All models were adjusted for prognostically important variables. Results In this study, 267 of 456 children (119 [44.6%] female; median [IQR] age, 12.9 [11.5 to 14.4] years) were included in the analysis. Participants with greater cMVPA had significantly lower HBI scores at 1 week (75th percentile [258.5 minutes] vs 25th percentile [90.0 minutes]; difference, -5.45 [95% CI, -7.67 to -3.24]) and 2 weeks postinjury (75th percentile [565.0 minutes] vs 25th percentile [237.0 minutes]; difference, -2.85 [95% CI, -4.74 to -0.97]) but not at 4 weeks postinjury (75th percentile [565.0 minutes] vs 25th percentile [237.0 minutes]; difference, -1.24 [95% CI, -3.13 to 0.64]) (P = .20). Symptom burden was not lower beyond the 75th percentile for cMVPA at 1 week or 2 weeks postinjury (1 week, 259 minutes; 2 weeks, 565 minutes) of cMVPA. The odds ratio for the association between 75th and 25th percentile of cMVPA and PSAC was 0.48 (95% CI, 0.24 to 0.94) at 2 weeks. Conclusions and Relevance In children and adolescents with acute concussion, 259 minutes of cMVPA during the first week postinjury and 565 minutes of cMVPA during the second week postinjury were associated with lower symptom burden at 1 week and 2 weeks postinjury. At 2 weeks postinjury, higher cMVPA volume was associated with 48% reduced odds of PSAC compared with lower cMVPA volume.
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Affiliation(s)
- Andrée-Anne Ledoux
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Veronik Sicard
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Vid Bijelić
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Michael M. Borghese
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Nicholas Kuzik
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Mark S. Tremblay
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern, Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Adrienne L. Davis
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gurinder Sangha
- Department of Pediatrics, Children’s Hospital London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Roger Leonard Zemek
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern, Ontario, University of Ottawa, Ottawa, Ontario, Canada
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Yuan K, Haddad Y, Law R, Shakya I, Haileyesus T, Navon L, Zhang L, Liu Y, Bergen G. Emergency Department Visits for Alcohol-Associated Falls Among Older Adults in the United States, 2011 to 2020. Ann Emerg Med 2023; 82:666-677. [PMID: 37204348 PMCID: PMC10950308 DOI: 10.1016/j.annemergmed.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Abstract
STUDY OBJECTIVE The aim of this study was to examine the epidemiology of alcohol-associated fall injuries among older adults aged ≥65 years in the United States. METHODS We included emergency department (ED) visits for unintentional fall injuries by adults from the National Electronic Injury Surveillance System-All Injury Program during 2011 to 2020. We estimated the annual national rate of ED visits for alcohol-associated falls and the proportion of these falls among older adults' fall-related ED visits using demographic and clinical characteristics. Joinpoint regression was performed to examine trends in alcohol-associated ED fall visits between 2011 and 2019 among older adult age subgroups and to compare these trends with those of younger adults. RESULTS There were 9,657 (weighted national estimate: 618,099) ED visits for alcohol-associated falls, representing 2.2% of ED fall visits during 2011 to 2020 among older adults. The proportion of fall-related ED visits that were alcohol-associated was higher among men than among women (adjusted prevalence ratio [aPR]=3.6, 95% confidence interval [CI] 2.9 to 4.5). The head and face were the most commonly injured body parts, and internal injury was the most common diagnosis for alcohol-associated falls. From 2011 to 2019, the annual rate of ED visits for alcohol-associated falls increased (annual percent change 7.5, 95% CI 6.1 to 8.9) among older adults. Adults aged 55 to 64 years had a similar increase; a sustained increase was not detected in younger age groups. CONCLUSION Our findings highlight the rising rates of ED visits for alcohol-associated falls among older adults during the study period. Health care providers in the ED can screen older adults for fall risk and assess for modifiable risk factors such as alcohol use to help identify those who could benefit from interventions to reduce their risk.
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Affiliation(s)
- Keming Yuan
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Yara Haddad
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Royal Law
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Iju Shakya
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Tadesse Haileyesus
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Livia Navon
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lei Zhang
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yang Liu
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gwen Bergen
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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Yeates KO, Barlow KM, Wright B, Tang K, Barrett O, Berdusco E, Black AM, Clark B, Conradi A, Godfrey H, Kolstad AT, Ly A, Mikrogianakis A, Purser R, Schneider K, Stang AS, Zemek R, Zwicker JD, Johnson DW. Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial. CAN J EMERG MED 2023; 25:627-636. [PMID: 37351798 PMCID: PMC10333406 DOI: 10.1007/s43678-023-00530-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs. METHODS Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care. RESULTS A total of 2878 unique patients (1164 female, 1713 male) aged 5-17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change - 23.76 min, 95% CI - 37.99, - 9.52). Total physician claims increased significantly at only 1 of 5 sites. CONCLUSIONS Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient. TRIAL REGISTRATION ClinicalTrials.gov NCT05095012.
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Affiliation(s)
- Keith Owen Yeates
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N1N4, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| | - Karen M Barlow
- Child Health Research Centre, Queensland Children's Hospital, University of Queensland, South Brisbane, Australia
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Women's and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Ken Tang
- Independent Statistical Consulting, Vancouver, BC, Canada
| | | | - Edward Berdusco
- Departments of Emergency Medicine and Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Amanda M Black
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
| | - Brenda Clark
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Alf Conradi
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Heather Godfrey
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, Alberta Children's Hospital, Calgary, AB, Canada
| | - Ashley T Kolstad
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
| | - Anh Ly
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N1N4, Canada
| | | | - Ross Purser
- Department of Emergency Medicine, Grey Nuns Hospital, Edmonton, AB, Canada
| | - Kathryn Schneider
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
| | - Antonia S Stang
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - David W Johnson
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
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Pappadis MR, Malagaris I, Kuo YF, Leland N, Freburger J, Goodwin JS. Care patterns and predictors of community residence among older patients after hospital discharge for traumatic brain injury. J Am Geriatr Soc 2023; 71:1806-1818. [PMID: 36840390 PMCID: PMC10330166 DOI: 10.1111/jgs.18308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 02/26/2023]
Abstract
BACKGROUND An increasing number of older adults with traumatic brain injury (TBI) require hospitalization, but it is unknown whether they return to their community following discharge. We examined community residence following acute hospital discharge for TBI in Texas and identified factors associated with 90-day community residence and readmission. METHODS We conducted a retrospective cohort study using 100% Texas Medicare claims data of patients older than 65 years hospitalized for a TBI from January 1, 2014, through December 31, 2017, and followed for 20 weeks after discharge. Discharges to short-term and long-term acute hospital, inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), long-term nursing home (NH), and hospice were identified. The primary outcome was 90-day community residence. Our secondary outcome was 90-day, all-cause readmission. RESULTS In Texas, 26,985 Medicare fee-for-service patients were hospitalized for TBI (Racial and ethnic minorities: 21.1%; Females 57.3%). At 90 days and 20 weeks following discharge, 80% and 84% were living in the community respectively. Female sex (OR = 1.16 [1.08-1.25]), Hispanic ethnicity (OR = 2.01 [1.80-2.25]), "other" race (OR = 2.19 [1.73-2.77]), and prior primary care provider (PCP; OR = 1.51 [1.40-1.62]) were associated with increased likelihood of 90-day community residence. Patients aged 75+, prior NH residence, dual eligibility, prior TBI diagnosis, and moderate-to-severe injury severity were associated with decreased likelihood of 90-day community residence. Being non-Hispanic Black (HR = 1.33 [1.20-1.46]), discharge to SNF (HR = 1.56 [1.48-1.65]) or IRF (HR = 1.49 [1.40-1.59]), having prior PCP (HR = 1.23 [1.17-1.30]), dual eligibility (HR = 1.11 [1.04-1.18]), and prior TBI diagnosis (HR = 1.05 [1.01-1.10]) were associated with increased risk of 90-day readmission. Female sex and "other" race were associated with decreased risk of 90-day readmission. CONCLUSIONS Most older adults with TBI return to the community following hospital discharge. Disparities exist in returning to the community and in risk of 90-day readmission following hospital discharge. Future studies should explore how having a PCP influences post-hospital outcomes in chronic care management of older patients with TBI.
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Affiliation(s)
- Monique R. Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB) at Galveston, Galveston, TX, USA
- Sealy Center on Aging, UTMB, Galveston, TX, USA
| | - Ioannis Malagaris
- Department of Biostatistics and Data Science, School of Public and Population Health, UTMB, Galveston, TX, USA
| | - Yong-Fang Kuo
- Sealy Center on Aging, UTMB, Galveston, TX, USA
- Department of Biostatistics and Data Science, School of Public and Population Health, UTMB, Galveston, TX, USA
| | - Natalie Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Janet Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - James S. Goodwin
- Sealy Center on Aging, UTMB, Galveston, TX, USA
- Department of Internal Medicine, Division of Geriatrics, School of Medicine, UTMB, Galveston, TX
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Waltzman D, Miller GF, Patel N, Sarmiento K, Breiding M, Lumba-Brown A. Neuroimaging for mild traumatic brain injury in children: cross-sectional study using national claims data. Pediatr Radiol 2023; 53:1163-1170. [PMID: 36859687 PMCID: PMC10416194 DOI: 10.1007/s00247-023-05633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Current guidelines recommend healthcare professionals avoid routine use of neuroimaging for diagnosing mild traumatic brain injury (mTBI). OBJECTIVE This study aimed to examine current use of CT and MRI among children and young adult patients with mTBI and factors that increase likelihood of neuroimaging in this population. MATERIALS AND METHODS Data were analyzed using the 2019 MarketScan commercial claims and encounters database for the commercially insured population for both inpatient and outpatient claims. Descriptive statistics and logistic regression models for patients ≤24 years of age who received an ICD-10-CM code indicative of a possible mTBI were analyzed. RESULTS Neuroimaging was performed in 16.9% (CT; 95% CI=16.7-17.1) and 0.9% (MRI; 95% CI=0.8-0.9) of mTBI outpatient visits (including emergency department visits) among children (≤18 years old). Neuroimaging was performed in a higher percentage of outpatient visits for patients 19-24 years old (CT=47.1% [95% CI=46.5-47.6] and MRI=1.7% [95% CI=1.5-1.8]), and children aged 15-18 years old (CT=20.9% [95% CI=20.5-21.2] and MRI=1.4% [95% CI=1.3-1.5]). Outpatient visits for males were 1.22 (95% CI=1.10-1.25) times more likely to include CT compared to females, while there were no differences by sex for MRI or among inpatient stays. Urban residents, as compared to rural, were less likely to get CT in outpatient settings (adjusted odds ratio [aOR]=0.55, 95% CI=0.53-0.57). Rural residents demonstrated a larger proportion of inpatient admissions that had a CT. CONCLUSIONS Despite recommendations to avoid routine use of neuroimaging for mTBI, neuroimaging remained common practice in 2019.
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Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA, 30341, USA.
| | - Gabrielle F Miller
- Division of Injury Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Nimesh Patel
- Division of Injury Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Kelly Sarmiento
- Division of Injury Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Matthew Breiding
- Division of Injury Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Angela Lumba-Brown
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
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10
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Adams RS, Hoover P, Forster JE, Caban J, Brenner LA. Traumatic Brain Injury Classification Variability During the Afghanistan/Iraq Conflicts: Surveillance, Clinical, Research, and Policy Implications. J Head Trauma Rehabil 2022; 37:361-370. [PMID: 36075868 PMCID: PMC9643596 DOI: 10.1097/htr.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Challenges associated with case ascertainment of traumatic brain injuries (TBIs) sustained during the Afghanistan/Iraq military operations have been widespread. This study was designed to examine how the prevalence and severity of TBI among military members who served during the conflicts were impacted when a more precise classification of TBI diagnosis codes was compared with the Department of Defense Standard Surveillance Case-Definition (DoD-Case-Definition). SETTING Identification of TBI diagnoses in the Department of Defense's Military Health System from October 7, 2001, until December 31, 2019. PARTICIPANTS Military members with a TBI diagnosis on an encounter record during the study window. DESIGN Descriptive observational study to evaluate the prevalence and severity of TBI with regard to each code set (ie, the DoD-Case-Definition and the more precise set of TBI diagnosis codes). The frequencies of index TBI severity were compared over time and further evaluated against policy changes. MAIN MEASURES The more precise TBI diagnosis code set excludes the following: (1) DoD-only extender codes, which are not used in other healthcare settings; and (2) nonprecise TBI codes, which include injuries that do not necessarily meet TBI diagnostic criteria. RESULTS When comparing the 2 TBI classifications, the DoD-Case-Definition captured a higher prevalence of TBIs; 38.5% were classified by the DoD-Case-Definition only (>164 000 military members). 73% of those identified by the DoD-Case-Definition only were diagnosed with nonprecise TBI codes only, with questionable specificity as to whether a TBI occurred. CONCLUSION We encourage the field to reflect on decisions made pertaining to TBI case ascertainment during the height of the conflicts. Efforts focused on achieving consensus regarding TBI case ascertainment are recommended. Doing so will allow the field to be better prepared for future conflicts, and improve surveillance, screening, and diagnosis in noncombat settings, as well as our ability to understand the long-term effects of TBI.
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Affiliation(s)
- Rachel Sayko Adams
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
| | - Peter Hoover
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jeri E. Forster
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jesus Caban
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Lisa A. Brenner
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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11
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Costich JF, Quesinberry DB, Daniels LK, Bush A. Trends in ICD-10-CM-Coded Administrative Datasets for Injury Surveillance and Research. South Med J 2022; 115:801-805. [PMID: 36318943 PMCID: PMC9612715 DOI: 10.14423/smj.0000000000001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Injury surveillance relies heavily on data created for administrative purposes. In the United States, the adoption of the clinical modification of the 10th edition of the International Classification of Diseases, Tenth Revision, Clinical Modification added thousands of potential injury codes, but few are used in administrative datasets. The widespread use of electronic health records has the potential to influence the data sources used for injury surveillance. This investigation explores how trends in clinical coding may affect the consistency of injury surveillance data. Objectives Accurate injury surveillance depends on data quality in administrative datasets created for billing and reimbursement. Significant effort has been devoted to testing the ability of candidate injury case definitions to identify injury cases accurately in these datasets. We used interviews with experienced coders, informed by a review of the current literature, to identify three clinical coding trends that may affect the consistency of surveillance data: “clinical documentation improvement or clinical documentation integrity” (CDI), coding by treating clinicians, and certain electronic health record features. Methods An extensive literature review informed interviews with coding experts to identify potential issues in coding practice. To determine whether physician coding was associated with information loss, we analyzed data from two hospitals serving the same geographic area. One hospital had used physician coding of emergency department data for the past decade; the other used professional coders. We compared the proportion of emergency department records missing external cause of injury codes and assessed the variation for statistical significance. Results CDI audits review patient records to ensure that billing information includes every relevant International Classification of Diseases, Tenth Revision, Clinical Modification code. This approach has increased payment rates awarded to Medicare Advantage plans because additional codes increase the patient acuity level and case mix index. The impact of CDI audits on injury data needs further investigation. The pilot analysis addressing information loss with physician coding found a higher level of external cause coding with clinician self-coding, possibly because of the coding software. Finally, widespread “copy and paste” in patient electronic health records has the potential to increase reported injuries. Conclusions Injury surveillance relies on billing and reimbursement records. Financial motivations may interfere with the consistency of surveillance findings and mislead injury epidemiologists. Further investigation is essential to ensure the integrity of surveillance findings.
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Affiliation(s)
- Julia F Costich
- From the Kentucky Injury Prevention & Research Center and the Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington
| | - Dana B Quesinberry
- From the Kentucky Injury Prevention & Research Center and the Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington
| | - Lara K Daniels
- From the Kentucky Injury Prevention & Research Center and the Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington
| | - Ashley Bush
- From the Kentucky Injury Prevention & Research Center and the Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington
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12
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Adolescents with a concussion have altered brain network functional connectivity one month following injury when compared to adolescents with orthopedic injuries. Neuroimage Clin 2022; 36:103211. [PMID: 36182818 PMCID: PMC9668608 DOI: 10.1016/j.nicl.2022.103211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
Concussion is a mild traumatic brain injury (mTBI) with increasing prevalence among children and adolescents. Functional connectivity (FC) within and between the default mode network (DMN), central executive network (CEN) and salience network (SN) has been shown to be altered post-concussion. Few studies have investigated connectivity within and between these 3 networks following a pediatric concussion. The present study explored whether within and between-network FC differs between a pediatric concussion and orthopedic injury (OI) group aged 10-18. Participants underwent a resting-state functional magnetic resonance imaging (rs-fMRI) scan at 4 weeks post-injury. One-way ANCOVA analyses were conducted between groups with the seed-based FC of the 3 networks. A total of 55 concussion and 27 OI participants were included in the analyses. Increased within-network FC of the CEN and decreased between-network FC of the DMN-CEN was found in the concussion group when compared to the OI group. Secondary analyses using spherical SN regions of interest revealed increased within-network FC of the SN and increased between-network FC of the DMN-SN and CEN-SN in the concussion group when compared to the OI group. This study identified differential connectivity patterns following a pediatric concussion as compared to an OI 4 weeks post-injury. These differences indicate potential adaptive brain mechanisms that may provide insight into recovery trajectories and appropriate timing of treatment within the first month following a concussion.
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13
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Gabella BA, Hume B, Li L, Mabida M, Costich J. Multi-site medical record review for validation of intentional self-harm coding in emergency departments. Inj Epidemiol 2022; 9:16. [PMID: 35672865 PMCID: PMC9175468 DOI: 10.1186/s40621-022-00380-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Codes in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), are used for injury surveillance, including surveillance of intentional self-harm, as they appear in administrative billing records. This study estimated the positive predictive value of ICD-10-CM codes for intentional self-harm in emergency department (ED) billing records for patients aged 10 years and older who did not die and were not admitted to an inpatient medical service.
Methods
The study team in Maryland, Colorado, and Massachusetts selected all or a random sample of ED billing records with an ICD-10-CM code for intentional self-harm (specific codes that began with X71-X83, T36-T65, T71, T14.91). Positive predictive value (PPV) was determined by the number and percentage of records with a physician diagnosis of intentional self-harm, based on a retrospective review of the original medical record.
Results
The estimated PPV for the codes’ capture of intentional self-harm based on physician diagnosis in the original medical record was 89.8% (95% CI 85.0–93.4) for Maryland records, 91.9% (95% CI 87.7–95.0) for Colorado records, and 97.3% (95% CI 95.1–98.7) for Massachusetts records.
Conclusion
Given the high PPV of the codes, epidemiologists can use the codes for public health surveillance of intentional self-harm treated in the ED using ICD-10-CM coded administrative billing records. However, these codes and related variables in the billing database cannot definitively distinguish between suicidal and non-suicidal intentional self-harm.
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14
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Costich JF, Vos SC, Quesinberry DB. Practitioners Assess Achievements and Challenges of Nonfatal Injury Surveillance. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:258-263. [PMID: 35334483 PMCID: PMC8956803 DOI: 10.1097/phh.0000000000001464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Injury surveillance relies on data coded for administrative rather than epidemiological accuracy. The Centers for Disease Control and Prevention (CDC) established the 5-year Surveillance Quality Improvement (SQI) initiative to advance consensus and methodology for injury epidemiology reporting and analysis. Evaluation of the positive predictive value of the CDC's injury surveillance definitions based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding in designated injury categories comprised much of the SQI initiative's work. The goal of the current study is to identify achievements and challenges in SQI as articulated by experienced injury epidemiology practitioners who participated in the CDC-funded SQI initiative. DESIGN, SETTING, AND PARTICIPANTS We conducted semistructured interviews with 12 representatives of state and federal public health agencies who had participated extensively in the SQI initiative. The interviews were transcribed and coded using NVivo qualitative analysis software. Initial coding of the data involved both in vivo coding (using the words of participants) and coding of a priori themes. MAIN OUTCOME MEASURES Qualitative analysis identified 2 overarching themes, variability among states and observations on the science of injury surveillance. RESULTS Within the 2 broad themes, the respondents provided valuable insights regarding access to medical records, case definition validation, unique contributions of medical record abstracting, variations in the practice of medical coding, and the potential for use of data from medical record reviews in other injury-related areas. CONCLUSIONS The contributions of the SQI initiative have provided valuable insights into ICD-10-CM case definitions for national injury surveillance. Challenges remain with regard to data access and quality with ongoing reliance on administrative datasets for injury surveillance.
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Affiliation(s)
- Julia F. Costich
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington (Drs Costich, Quesinberry, and Vos); Kentucky Injury Prevention & Research Center, Lexington (Drs Costich and Quesinberry)
| | - Sarah C. Vos
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington (Drs Costich, Quesinberry, and Vos); Kentucky Injury Prevention & Research Center, Lexington (Drs Costich and Quesinberry)
| | - Dana B. Quesinberry
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington (Drs Costich, Quesinberry, and Vos); Kentucky Injury Prevention & Research Center, Lexington (Drs Costich and Quesinberry)
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15
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Carmichael AE, Ballesteros MF, Qualters JR, Mack KA. Non-fatal injury data: characteristics to consider for surveillance and research. Inj Prev 2022; 28:262-268. [PMID: 35210312 DOI: 10.1136/injuryprev-2021-044397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/10/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND All data systems used for non-fatal injury surveillance and research have strengths and limitations that influence their utility in understanding non-fatal injury burden. The objective of this paper was to compare characteristics of major data systems that capture non-fatal injuries in the USA. METHODS By applying specific inclusion criteria (eg, non-fatal and non-occupational) to well-referenced injury data systems, we created a list of commonly used non-fatal injury data systems for this study. Data system characteristics were compiled for 2018: institutional support, years of data available, access, format, sample, sampling method, injury definition/coding, geographical representation, demographic variables, timeliness (lag) and further considerations for analysis. RESULTS Eighteen data systems ultimately fit the inclusion criteria. Most data systems were supported by a federal institution, produced national estimates and were available starting in 1999 or earlier. Data source and injury case coding varied between the data systems. Redesigns of sampling frameworks and the use of International Classification of Diseases, 9th Revision, Clinical Modification/International Classification of Diseases, 10th Revision, Clinical Modification coding for some data systems can make longitudinal analyses complicated for injury surveillance and research. Few data systems could produce state-level estimates. CONCLUSION Thoughtful consideration of strengths and limitations should be exercised when selecting a data system to answer injury-related research questions. Comparisons between estimates of various data systems should be interpreted with caution, given fundamental system differences in purpose and population capture. This research provides the scientific community with an updated starting point to assist in matching the data system to surveillance and research questions and can improve the efficiency and quality of injury analyses.
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Affiliation(s)
- Andrea E Carmichael
- Oak Ridge Associated Universities (ORAU), Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA .,Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael F Ballesteros
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Judith R Qualters
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karin A Mack
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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16
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Ledoux AA, Barrowman N, Bijelić V, Borghese MM, Davis A, Reid S, Sangha G, Yeates KO, Tremblay MS, McGahern C, Belanger K, Barnes JD, Farion KJ, DeMatteo CA, Reed N, Zemek R. Is early activity resumption after paediatric concussion safe and does it reduce symptom burden at 2 weeks post injury? The Pediatric Concussion Assessment of Rest and Exertion (PedCARE) multicentre randomised clinical trial. Br J Sports Med 2021; 56:271-278. [PMID: 34836880 DOI: 10.1136/bjsports-2021-105030] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Investigate whether resuming physical activity (PA) at 72 hours post concussion is safe and reduces symptoms at 2 weeks, compared with resting until asymptomatic. METHODS Real-life conditions, multicentre, single-blinded randomised clinical trial, conducted in three Canadian paediatric emergency departments (ED). Children/youth aged 10-<18 years with acute concussion were recruited between March 2017 and December 2019, and randomly assigned to a 4-week stepwise return-to-PA protocol at 72 hours post concussion even if symptomatic (experimental group (EG)) or to a return-to-PA once asymptomatic protocol (control group (CG)). The primary outcome was self-reported symptoms at 2 weeks using the Health and Behaviour Inventory. Adherence was measured using accelerometers worn 24 hours/day for 14 days post injury. Adverse events (AE) (worsening of symptoms requiring unscheduled ED or primary care visit) were monitored. Multivariable intention-to-treat (ITT) and per-protocol analyses adjusting for prognostically important covariates were examined. Missing data were imputed for the ITT analysis. RESULTS 456 randomised participants (EG: N=227; mean (SD) age=13.3 (2.1) years; 44.5% women; CG: N=229; mean (SD) age=13.3 (2.2) years; 43.7% women) were analysed. No AE were identified. ITT analysis showed no strong evidence of a group difference at 2 weeks (adjusted mean difference=-1.3 (95% CI:-3.6 to 1.1)). In adherent participants, initiating PA 72 hours post injury significantly reduced symptoms 2 weeks post injury, compared with rest (adjusted mean difference=-4.3 (95% CI:-8.4 to -0.2)). CONCLUSION Symptoms at 2 weeks did not differ significantly between children/youth randomised to initiate PA 72 hours post injury versus resting until asymptomatic; however, many were non-adherent to the intervention. Among adherent participants, early PA was associated with reduced symptoms at 2 weeks. Resumption of PA is safe and may be associated with milder symptoms at 2 weeks. LEVEL OF EVIDENCE 1b. TRIAL REGISTRATION NUMBER NCT02893969. REGISTRY NAME Pediatric Concussion Assessment of Rest and Exertion (PedCARE).
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Affiliation(s)
- Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada .,Cellular and Molecular Medicine- Neuroscience, University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Vid Bijelić
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Michael M Borghese
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Adrienne Davis
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Sarah Reid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Division of Emergency Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Gurinder Sangha
- Division of Emergency Medicine, Department of Pediatrics, Western University, London, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Candice McGahern
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kevin Belanger
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Joel D Barnes
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ken J Farion
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Division of Emergency Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Carol A DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Division of Emergency Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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17
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Gabella BA, Hathaway JE, Hume B, Johnson J, Costich JF, Slavova S, Liu AY. Multisite medical record review of emergency department visits for traumatic brain injury. Inj Prev 2021; 27:i42-i48. [PMID: 33674332 PMCID: PMC7948178 DOI: 10.1136/injuryprev-2019-043510] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 10/01/2020] [Accepted: 11/19/2020] [Indexed: 11/13/2022]
Abstract
Background In 2016, the CDC in the USA proposed codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for identifying traumatic brain injury (TBI). This study estimated positive predictive value (PPV) of TBI for some of these codes. Methods Four study sites used emergency department or trauma records from 2015 to 2018 to identify two random samples within each site selected by ICD-10-CM TBI codes for (1) intracranial injury (S06) or (2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) with no other TBI codes. Using common protocols, reviewers abstracted TBI signs and symptoms and head imaging results that were then used to assign certainty of TBI (none, low, medium, high) to each sampled record. PPVs were estimated as a percentage of records with medium-certainty or high-certainty for TBI and reported with 95% confidence interval (CI). Results PPVs for intracranial injury codes ranged from 82% to 92% across the four samples. PPVs for skull fracture codes were 57% and 61% in the two university/trauma hospitals in each of two states with clinical reviewers, and 82% and 85% in the two states with professional coders reviewing statewide or nearly statewide samples. Margins of error for the 95% CI for all PPVs were under 5%. Discussion ICD-10-CM codes for traumatic intracranial injury demonstrated high PPVs for capturing true TBI in different healthcare settings. The algorithm for TBI certainty may need refinement, because it yielded moderate-to-high PPVs for records with skull fracture codes that lacked intracranial injury codes.
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Affiliation(s)
- Barbara A Gabella
- Violence and Injury Prevention - Mental Health Promotion Branch, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Jeanne E Hathaway
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Beth Hume
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Jewell Johnson
- Violence and Injury Prevention - Mental Health Promotion Branch, Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Julia F Costich
- Department of Health Management and Policy, University of Kentucky, Lexington, Kentucky, USA
| | - Svetla Slavova
- Kentucky Injury Prevention and Research Center, University of KY, Lexington, Kentucky, USA
| | - Ann Y Liu
- Center for Environmental and Occupational Epidemiology, Maryland Department of Health, Baltimore, Maryland, USA
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18
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De Crescenzo LA, Gabella BA, Johnson J. Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury. Inj Epidemiol 2021; 8:15. [PMID: 33866966 PMCID: PMC8054413 DOI: 10.1186/s40621-021-00308-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/16/2021] [Indexed: 11/11/2022] Open
Abstract
Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.
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Affiliation(s)
| | - Barbara Alison Gabella
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, A4, Denver, CO, USA.
| | - Jewell Johnson
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, A4, Denver, CO, USA
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19
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Johnson RL, Hedegaard H, Pasalic ES, Martinez PD. Use of ICD-10-CM coded hospitalisation and emergency department data for injury surveillance. Inj Prev 2021; 27:i1-i2. [PMID: 33674325 PMCID: PMC7948190 DOI: 10.1136/injuryprev-2019-043515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Renee L Johnson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Holly Hedegaard
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA
| | - Emilia S Pasalic
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pedro D Martinez
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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