Traumatic Brain Injury Classification

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Traumatic Brain Injury Classification
Limor Aharonson-Daniel, PhD
For International Collaborative Effort on Injury
Statistics, Washington DC, September 7-8, 2006
Israel national center for trauma and emergency
medicine research Gertner Institute for
Epidemiology and Health Policy Research
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• In 1995, clinical case definition standardized
• It included any intracranial injury and any
  reported loss of consciousness or concussion.

Guidelines for Surveillance of Central Nervous
System Injury Thurman DJ, Sniezek JE, Jonson D,
Greenspan A, Smith SM Atlanta Centers for
disease Control and Prevention, 1995).
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Fracture Internal Nerves
ICD-9-CM
The definition encompasses a wide range of
conditions which are easily, and with clinical
reasoning, classifiable into two very distinctive
groups of patients
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Type 1 TBI recorded evidence of an
intracranial injury or a moderate or a prolonged
loss of consciousness   Shaken Infant Syndrome
and injuries to the optic nerve pathways. Type 2
TBI no recorded evidence of intracranial injury
and a  loc of less than one hour, a loc of
unknown duration or an unspecified level of
consciousness.  Type 3 TBI no evidence of
intracranial injury and no loc.
Barell matrix definitions
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• We highly recommend the development of research
  guidelines to standardize definitional, case
  finding, and data reporting parameters to help
  establish a more precise description and hence
  utility of the epidemiology of TBI in Europe.

It was difficult to reach a consensus on all
epidemiological findings across the 23 published
European studies because of critical differences
in methods employed across the reports.
A systematic review of brain injury epidemiology
in Europe F. Tagliaferri, C. Compagnone, M.
Korsic, F. Servadei, and J. Kraus Acta Neurochir
(Wien) (2005) Published online November 28, 2005
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Langlois JA, Rutland-Brown W, Thomas KE.
Traumatic Brain Injury in the United States
Emergency Department Visits, Hospitalizations,
and Deaths. Atlanta (GA) Centers for Disease
Control and Prevention, National Center for
Injury Prevention and Control 2006.

The ICD-9-CM codes for TBI included in the
analysis differed slightly from those in the
Barell Matrix, a recommended categorization of
ICD-9-CM codes for nonfatal injuries. The
inclusion of 959.01 (head injury, unspecified)
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ICD-9-CM codes for traumatic brain injury related
ED visits (1995-2001)
Fracture of the vault or base of the skull
800.0801.9 Other and unqualified multiple
fractures of the skull 803.0804.9 Intracrania
l injury, including concussion, contusion,
laceration, and hemorrhage
850.0854.1 Head injury, unspecified
959.01
995.55, 950(.1-.3)
Langlois JA, Rutland-Brown W, Thomas KE.
Traumatic Brain Injury in the United States
Emergency Department Visits, Hospitalizations,
and Deaths. Atlanta (GA) Centers for Disease
Control and Prevention, National Center for
Injury Prevention and Control 2006.
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Epidemiology of Emergency Department-Treated
Traumatic Brain Injury in Minnesota Day H,
Roesler J, Gaichas A, Kinde M, Accessed at
http//www.mmaonline.net/Publications/MNMed2006/Ma
y/clinical-day.htm on aug 4 2006
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Mild traumatic brain injury in the United States,
19982000

• skull fracture (800.0, 800.5, 801.0, 801.5,
  803.0, 803.5, 804.0, 804.5),
• concussion (850.0, 850.1, 850.5, 850.9),
  intracranial
• injury of unspecified nature (854.0) and head
• injury, unspecified (959.0).
• These codes are intended to identify TBIs that
  approximate the mTBI clinical definition. They
  were recommended as the administrative case
  definition of mTBI for surveillance and research
  by the Centers for Disease Control and Prevention
  Mild Traumatic Brain Injury Work Group in October
  2002.

Includes cases where there is no intracranial
injury even if there is an extended (gt24h) LOC
BAZARIAN JJ, MCCLUNG J, SHAH MN, CHENG YT,
FLESHER W KRAUS J Brain Injury, February 2005
19(2) 8591
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A look at the data
Population and methods
Retrospective analysis of TBI data recorded in
the Israel National Trauma Registry
1/1/1998-12/31/2005. Patients were included if
they had isolated TBI.
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AGE distribution by type of TBI
1998-2005, 7408 patients with isolated TBI
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SEVERITY OF INJURY (ISS)
1998-2005, 7408 patients with isolated TBI
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Type of TBI by injury severity
Among all TBI (n7408)
Among ISS 16 (n3077)
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Severity Indicators
1998-2005, 7408 patients with isolated TBI
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Conclusion Groups seem valid. Need to touch up
definitions and finish the work begun a decade
ago
Implications for ICD-11?
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Partners? NCIPC ANA
Do we agree that it is our business to improve
and disseminate a uniform / multi-leveled TBI
definition?
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Thank you.