Are We Underestimating the Burden of Traumatic Brain Injury? Surveillance of Severe Traumatic Brain Injury Using Centers for Disease Control International Classification of Disease, Ninth Revision, Clinical Modification, Traumatic Brain Injury Codes

Carroll, C. Patrick; Cochran, Joseph; Guse, Clare E.; Wang, Marjorie C.

doi:10.1227/neu.0b013e31826f7c16

Cited by 79 publications

(64 citation statements)

References 17 publications

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“…Although the clinical criteria for PCS also require the presence of at least 3 symptoms 1 month after concussion, the diagnostic accuracy of this definition is a topic of scientific debate as it is both subjective and imprecise. [39][40][41] There is also significant controversy as to whether the term "syndrome" is appropriate, given that common concussion symptoms are also found in patients who do not have concussion. 42 Regardless of these shortcomings, PCS …”

Section: Discussionmentioning

confidence: 99%

Acute Concussion Symptom Severity and Delayed Symptom Resolution

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Children are often evaluated in the emergency department after a concussion. Although prolonged symptoms are associated with higher initial symptom severity when measured 2 to 3 weeks after injury, a similar association with acute symptom severity has not been demonstrated. WHAT THIS STUDY ADDS:Higher acute symptom severity is not associated with development of persistent post-concussion symptoms 1 month after injury, but persistent post-concussive symptoms affect a significant number of children after concussion. Outpatient follow-up is essential to identify children who develop persistent symptoms. abstract BACKGROUND AND OBJECTIVES: Up to 30% of children who have concussion initially evaluated in the emergency department (ED) display delayed symptom resolution (DSR). Greater initial symptom severity may be an easily quantifiable predictor of DSR. We hypothesized that greater symptom severity immediately after injury increases the risk for DSR. METHODS:We conducted a prospective longitudinal cohort study of children 8 to 18 years old presenting to the ED with concussion. Acute symptom severity was assessed using a graded symptom inventory. Presence of DSR was assessed 1 month later. Graded symptom inventory scores were tested for association with DSR by sensitivity analysis. We conducted a similar analysis for post-concussion syndrome (PCS) as defined by the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Potential symptoms characteristic of DSR were explored by using hierarchical cluster analysis. RESULTS:We enrolled 234 subjects; 179 (76%) completed follow-up. Thirtyeight subjects (21%) experienced DSR. Initial symptom severity was not significantly associated with DSR 1 month after concussion. A total of 22 subjects (12%) had PCS. Scores .10 (possible range, 0-28) were associated with an increased risk for PCS (RR, 3.1; 95% confidence interval 1.2-8.0). Three of 6 of the most characteristic symptoms of DSR were also most characteristic of early symptom resolution. However, cognitive symptoms were more characteristic of subjects reporting DSR.CONCLUSIONS: Greater symptom severity measured at ED presentation does not predict DSR but is associated with PCS. Risk stratification therefore depends on how the persistent symptoms are defined. Cognitive symptoms may warrant particular attention in future study. Follow-up is recommended for all patients after ED evaluation of concussion to monitor for DSR. Dr Grubenhoff conceptualized and designed the study, designed the database, oversaw data collection and analysis, drafted the initial manuscript, and reviewed and revised the manuscript; Ms Deakyne performed the primary statistical analysis, assisted with study design and database design, managed study personnel in recruitment and data acquisition, and co-authored, reviewed, and revised the manuscript; Ms Brou assisted with the cluster analysis and drafting and reviewed and revised the manuscript; Dr Bajaj assisted with study design and ...

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Section: Discussionmentioning

confidence: 99%

Acute Concussion Symptom Severity and Delayed Symptom Resolution

et al. 2014

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“…17,25 Our secondary outcome was the number of patients in the discordant cohort who ultimately had a neurosurgical intervention (ICD-9-CM codes 01.09, 01. 10 27 …”

Section: Measurements and Key Outcomes Measuredmentioning

confidence: 99%

Computed Tomography Use for Adults With Head Injury: Describing Likely Avoidable Emergency Department Imaging Based on the Canadian CT Head Rule

Sharp

Nagaraj

Rippberger

et al. 2017

Academic Emergency Medicine

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“…41,42 This code has been validated with high specificity (99%) and midrange sensitivity (22%-76%). [43][44][45] Patients who were admitted to hospital immediately or within 2 days of injury were excluded because such cases tend to reflect severe brain injury (a known risk factor for suicide) and do not represent ambulatory patients with concussion. 46,47 Patients under 17 years of age were excluded because most suicide deaths occur in adults.…”

Section: Patient Selectionmentioning

confidence: 99%