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Early Identification and Incidence of Mild TBI in Ontario

Published online by Cambridge University Press:  02 December 2014

Won Hyung A. Ryu ,
Anthony Feinstein ,
Angela Colantonio ,
David L. Streiner  and
Deirdre R. Dawson
Won Hyung A. Ryu
Affiliation:
Kunin-Lunenfeld Applied Research Unit, Baycrest Graduate Department of Rehabilitation Science, University of Toronto Toronto Rehabilitation Institute
Anthony Feinstein
Affiliation:
Department of Psychiatry, University of Toronto Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Angela Colantonio
Affiliation:
Graduate Department of Rehabilitation Science, University of Toronto Department of Occupational Science & Occupational Therapy, University of Toronto Toronto Rehabilitation Institute
David L. Streiner
Affiliation:
Kunin-Lunenfeld Applied Research Unit, Baycrest Graduate Department of Rehabilitation Science, University of Toronto Department of Psychiatry, University of Toronto
Deirdre R. Dawson*
Affiliation:
Kunin-Lunenfeld Applied Research Unit, Baycrest Graduate Department of Rehabilitation Science, University of Toronto Department of Occupational Science & Occupational Therapy, University of Toronto Toronto Rehabilitation Institute
*
Kunin-Lunenfeld Applied Research Unit, Baycrest, 3560 Bathurst St., Toronto, Ontario, M6A 2E1, Canada
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Abstract

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Objectives:

(1) To examine the variability in diagnosis of mild traumatic brain injury (mTBI) in primary care relative to that of an expert reviewer; and (2) to determine the incidence rate of mTBI in Ontario, Canada.

Method:

Potential mTBI cases were identified through reviewing three months of Emergency Department (ED) and Family Physician (FP) health records. Potential cases were selected from ED records using the International Classification of Disease, 9th revision, Clinical Modification and External Cause codes and from all FPs records for the time period. Documented diagnoses of mTBI were compared to expert reviewer diagnosis. Incidence of mTBI was determined using the documented diagnoses and data from hospital catchment areas and population census.

Results:

876 potential mTBI cases were identified, 25 from FP records. Key indicators of mTBI were missing on many records (e.g., 308/876 records had Glasgow Coma Scale (GCS) scores). The expert reviewer disagreed with the documented diagnosis in 380/876 cases (kappa=0.19). The expert reviewer was more likely to give a diagnosis if the GCS was 13-14, if there was documented loss of consciousness and/or post-traumatic amnesia, and/or if there was pathology found on an acute brain scan. Calculated incidence rates of hospital-treated mTBI were 426 or 535/100,000 (expert review - hospital diagnosis). Including family physician cases increased the rate to 493 or 653/100,000.

Conclusion:

Health record documentation of key indicators for mTBI is often lacking. Notwithstanding, some patients with mTBI appear to be missed or misdiagnosed by primary care physicians. A more comprehensive case definition resulted in estimated incidence rates higher than previous reports.

Résumé:

RÉSUMÉ:Objectifs :

(1) Examiner la variabilité dans le diagnostic du traumatisme cérébral léger (TCL) en première ligne par rapport au diagnostic d’un réviseur expert et (2) déterminer le taux d’incidence du TCL en Ontario, Canada.

Méthode :

Nous avons identifié les cas potentiels de TCL par révision des dossiers du service des urgences et des médecins de famille sur une période de trois mois. Les cas potentiels identifiés à partir des dossiers du service des urgences au moyen de la Classification internationale des maladies, 9e révision, modification clinique et codes des causes externes, et de tous les dossiers des médecins de famille pour ces trois mois. Les diagnostics de TCL certains selon les dossiers ont été comparés aux diagnostics de l’expert réviseur pour ces mêmes cas. L’incidence de TCL a été déterminée d’une part au moyen des diagnostics certains et des données hospitalières des secteurs sanitaires et d’autre part du recensement de population.

Résultats :

Huit cent soixante-seize cas potentiels de TCL ont été identifiés dont 25 à partir des dossiers des médecins de famille. Des indicateurs clés d’un TCL étaient absents de plusieurs dossiers (par exemple 308/876 dossiers contenaient un score du Glasgow Coma Scale (GCS)). Le réviseur expert était en désaccord avec le diagnostic établi chez 380/876 cas (kappa = 0,19). Le réviseur expert était plus enclin à poser ce diagnostic si le score GCS était de 13 ou 14, si le patient avait perdu conscience et/ou avait présenté une amnésie post-traumatique et/ou si le scan cérébral effectué en phase aiguë était pathologique. Les taux d’incidence calculés pour les cas de TCL traités à l’hôpital étaient de 426 ou 535/100,000 (révision par l’expert - diagnostics hospitaliers). Si on inclut les cas des médecins de famille, le taux passait à 493 ou 653/100,000.

Conclusion :

Les indicateurs clés de TCL sont souvent absents des dossiers médicaux. Néanmoins, il semble que le diagnostic de TCL soit manqué ou qu’un diagnostic erroné soit posé par le médecin de première ligne. Une définition de cas plus complète a fourni des taux d’incidence estimés plus élevés que ceux rapports antérieurement.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 4 , July 2009 , pp. 429 - 435
Copyright
Copyright © The Canadian Journal of Neurological 2009

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