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Comparison of different definitions of traumatic brain injury: implications for cohort characteristics and survival in women, Philadelphia, USA
  1. Bernadette A D'Alonzo1,
  2. Abigail C Bretzin2,
  3. Andrea LC Schneider1,3,
  4. Rebecca B Morse1,
  5. Silvia P Canelón4,
  6. Douglas J Wiebe2,5,
  7. Mary Regina Boland6,7
  1. 1Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  2. 2Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  4. 4Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  5. 5University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  6. 6Department of Mathematics, Saint Vincent College, Latrobe, Pennsylvania, USA
  7. 7Department of Marketing, Analytics and Global Commerce, Saint Vincent College, Latrobe, Pennsylvania, USA
  1. Correspondence to Dr Bernadette A D'Alonzo, Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; dalonzob{at}pennmedicine.upenn.edu

Abstract

Background Traumatic brain injury (TBI) is an acute injury that is understudied in civilian cohorts, especially among women, as TBI has historically been considered to be largely a condition of athletes and military service people. Both the Centres for Disease Control and Prevention (CDC) and Department of Defense (DOD)/Veterans Affairs (VA) have developed case definitions to identify patients with TBI from medical records; however, their definitions differ. We sought to re-examine these definitions to construct an expansive and more inclusive definition among a cohort of women with TBI.

Methods In this study, we use electronic health records (EHR) from a single healthcare system to study the impact of using different case definitions to identify patients with TBI. Specifically, we identified adult female patients with TBI using the CDC definition, DOD/VA definition and a combined and expanded definition herein called the Penn definition.

Results We identified 4446 adult-female TBI patients meeting the CDC definition, 3619 meeting the DOD/VA definition, and together, 6432 meeting our expanded Penn definition that includes the CDC ad DOD/VA definitions.

Conclusions Using the expanded definition identified almost two times as many patients, enabling investigations to more fully characterise these patients and related outcomes. Our expanded TBI case definition is available to other researchers interested in employing EHRs to investigate TBI.

  • Traumatic Brain Injury
  • Cohort Study
  • Epidemiology
  • Standards

Data availability statement

We will make all relevant code and other shareable resources available on our GitHub page: https://github.com/bolandlab.

https://doi.org/10.1136/ip-2023-045069

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    Data availability statement

    We will make all relevant code and other shareable resources available on our GitHub page: https://github.com/bolandlab.

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    Footnotes

    • X @berndalonzo

    • Presented at Work that motivated the current study has been presented previously at the Society for the Advancement of Violence and Injury Research (SAVIR), and the American Medical Informatics Association (AMIA) annual meetings.

    • Contributors B.A.D. and M.R.B. conceived of the study design. B.A.D., R.B.M., and M.R.B. developed the methodology with input from S.P.C. and D.J.W. A.L.C.S. conducted the manual chart review and with A.C.B., provided clinical insights pertinent to the study, and interpretation of results. B.A.D. and M.R.B. drafted the manuscript. All authors reviewed, edited, and approved the final manuscript. B.A.D. and M.R.B. accept full responsibility for the work and conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding The research reported in this manuscript is supported, in part, by the Penn Injury Science Center, which is an Injury Control Research Center funded by the Centers for Disease Control and Prevention, with a pilot grant funding to Dr. MRB (R49CE003083) that covered efforts by Dr. SPC. The research was also supported by the Institutional Clinical and Translational Science Award (CTSA) with Dr. MRB as a co-Investigator (UL1-TR-001878), with Dr. Garret Fitzgerald as PI. Dr. ACB was supported in part by the National Institute of Health–National Institute of Neurological Disorders and Stroke Brain Injury Training Grant (T32 NS 043126). Dr. ALCS is supported in part by NIH grant K23NS123340. Some funding also provided by the University of Pennsylvania via start-up funding to Dr. MRB.

    • Competing interests ALCS is an Associate Editor at Neurology. DJW provides consulting services on the topic of concussion/TBI epidemiology to the NCAA.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer-reviewed.