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Validation of a Case Definition for Pediatric Brain Injury Using Administrative Data

  • Jane McChesney-Corbeil (a1) (a2), Karen Barlow (a3), Hude Quan (a1), Guanmin Chen (a1), Samuel Wiebe (a1) (a2) and Nathalie Jette (a1) (a2)...


Background: Health administrative data are a common population-based data source for traumatic brain injury (TBI) surveillance and research; however, before using these data for surveillance, it is important to develop a validated case definition. The objective of this study was to identify the optimal International Classification of Disease , edition 10 (ICD-10), case definition to ascertain children with TBI in emergency room (ER) or hospital administrative data. We tested multiple case definitions. Methods: Children who visited the ER were identified from the Regional Emergency Department Information System at Alberta Children’s Hospital. Secondary data were collected for children with trauma, musculoskeletal, or central nervous system complaints who visited the ER between October 5, 2005, and June 6, 2007. TBI status was determined based on chart review. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each case definition. Results: Of 6639 patients, 1343 had a TBI. The best case definition was, “1 hospital or 1 ER encounter coded with an ICD-10 code for TBI in 1 year” (sensitivity 69.8% [95% confidence interval (CI), 67.3-72.2], specificity 96.7% [95% CI, 96.2-97.2], PPV 84.2% [95% CI 82.0-86.3], NPV 92.7% [95% CI, 92.0-93.3]). The nonspecific code S09.9 identified >80% of TBI cases in our study. Conclusions: The optimal ICD-10–based case definition for pediatric TBI in this study is valid and should be considered for future pediatric TBI surveillance studies. However, external validation is recommended before use in other jurisdictions, particularly because it is plausible that a larger proportion of patients in our cohort had milder injuries.

Validation d’une définition de cas de la lésion cérébrale chez l’enfant au moyen de données administratives. Contexte : Les données administratives sur la santé sont une source courante d’informations sanitaires populationnelles pour la surveillance et la recherche sur le traumatisme crânien (TC). Cependant, avant d’utiliser ces données à des fins de surveillance, il est important d’établir une définition de cas validée. L’objectif de cette étude était d’identifier la définition de cas optimale de la 10e édition de la Classification internationale des maladies (CIM-10), pour identifier les enfants atteints d’un TC à la salle d’urgence ou dans les données administratives hospitalières. Nous avons évalué plusieurs définitions de cas. Méthodologie : Les enfants qui se sont présentés à la salle d’urgence ont été identifiés dans le Regional Emergency Department Information System de l’Hôpital pour enfants de l’Alberta. Nous avons recueilli les données secondaires des enfants qui se sont présentés à la salle d’urgence pour des problèmes d’origine traumatique, musculosquelettiques ou du système nerveux central entre le 5 octobre 2005 et le 6 juin 2007. Nous avons déterminé s’ils présentaient un TC au moyen d’une revue de dossiers. Nous avons calculé la sensibilité, la spécificité, la valeur prédictive positive (VPP) et la valeur prédictive négative (VPN) de chaque définition de cas. Résultats : Parmi les 6 639 patients, 1 343 avaient subi un TC. La meilleure définition de cas était « une visite à l’hôpital ou une visite à la salle d’urgence portant le code de la CIM-10 pour le TC au cours d’une période d’un an » (sensibilité de 69,8% et IC à 95% : 67,3 à 72,2 ; spécificité de 96,7% et IC à 95% de 96,2 à 97,2 ; VPP de 84,2% et IC à 95% de 82,0 à 86,3 ; VPN de 92,7% et IC à 95% de 92,0 à 93,3). Le code non spécifique S09,9 identifiait plus de 80% des cas de TC dans notre étude. Conclusions : Dans cette étude, la définition de cas optimale basée sur la CIM-10 du TC chez l’enfant est valide et devrait être prise en compte dans les études de surveillance du TC chez l’enfant à l’avenir. Cependant, nous recommandons de procéder à une validation externe avant son utilisation dans d’autres juridictions, parce qu’il est plausible qu’une grande proportion de patients dans notre cohorte étaient atteints de blessures plus légères.

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Corresponding author

Correspondence to: Nathalie Jetté, Foothills Medical Center, Department of Clinical Neurosciences, 1403 29th Street NW, Calgary, Alberta T2N 4N1, Canada. Email:


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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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