Case ascertainment in pediatric traumatic brain injury: Challenges in using the NEISS

Abstract

The current approach of pediatric TBI case ascertainment in the NEISS faces some challenges in identifying mild TBI. Future research efforts are needed to refine TBI case ascertainment in the NEISS.

Basketball-Related Injuries in School-Aged Children and Adolescents in 1997–2007

“…For this study, cases were assigned a TBI code if the patient received either a (1) diagnosis code for concussion, (2) a body part code for head with a diagnosis code for fracture, or (3) a body part code for head with a diagnosis code for internal injury. 13 The locale where the injury occurred was categorized as sports or recreational place, school, home (home, farm, or mobile home), or other (street/highway, other public property, or industrial place). Case disposition was categorized as hospitalized (treated and admitted for hospitalization, treated and transferred to another hospital, or held for observation) or not hospitalized (treated and released, examined and released without treatment, or left without being seen/left against medical advice).…”

Surveillance of paediatric traumatic brain injuries using the NEISS: Choosing an appropriate case definition

“…A dataset of all NEISS cases collected at the hospital in 2008 meeting the TBI definition recommended by Xiang et al [16] was obtained from the CPSC. Although the hospital is a NEISS All Injury Programme (NEISS-AIP) site and the data collected for this study included all injuries, rather than just consumer product-related injuries, the dataset contained additional data not available in the NEISS-AIP public use data files because CDC excludes non-injury cases in their public release of the data (personal communication, Tom Schroeder, July 2013).…”

“…The NEISS definition of TBI including only the diagnosis code for concussion resulted in a sensitivity of 38.9%, compared to the sensitivity of 79.6% that was achieved when cases with the body part code equalling head and the diagnosis code equalling internal organ injury were added to the TBI definition. Due to the CDC's classification of fractures to the head as TBIs, Xiang et al [16] suggested that the NEISS definition should be improved by also including cases coded with the body part code for head and the diagnosis code for fracture [1,4]. While some studies have adopted this definition [9][10][11][12][13], no study has specifically evaluated this more comprehensive definition.…”

“…For example, some studies identify a case as a TBI if the body part coded is the head and the diagnosis is coded as a concussion or an internal organ injury [6,14,15], while others use the more inclusive definition of body part head and a diagnosis of concussion, internal organ injury or fracture [9][10][11][12][13]. To the authors' knowledge, only one peer-reviewed study has investigated the definition of TBI used in NEISS data analyses [16]. Using a small sample of NEISS cases collected at a single institution (n ¼ 880) and their corresponding original ICD-9-CM coded medical record, Xiang et al [16] evaluated the specificity and sensitivity of two different NEISS TBI definitions for paediatric Medicaid patients by comparing case ascertainment using the NEISS definitions vs. case ascertainment using the CDC standard definition for mild TBI.…”

“…To the authors' knowledge, only one peer-reviewed study has investigated the definition of TBI used in NEISS data analyses [16]. Using a small sample of NEISS cases collected at a single institution (n ¼ 880) and their corresponding original ICD-9-CM coded medical record, Xiang et al [16] evaluated the specificity and sensitivity of two different NEISS TBI definitions for paediatric Medicaid patients by comparing case ascertainment using the NEISS definitions vs. case ascertainment using the CDC standard definition for mild TBI. The NEISS definition of TBI including only the diagnosis code for concussion resulted in a sensitivity of 38.9%, compared to the sensitivity of 79.6% that was achieved when cases with the body part code equalling head and the diagnosis code equalling internal organ injury were added to the TBI definition.…”