Idea Transcript
VALIDITY OF ADMINISTRATIVE DATA FOR IDENTIFYING TRAUMATIC BRAIN INJURY: A SYSTEMATIC REVIEW J. McChesney, C. Smith, A. Metcalfe, J. Roberts, H. Quan, B. Hemmelgarn, T. Pringsheim, C. Beck, N. Jetté
CAHSPR Conference
May 11th, 2011
Halifax, Nova Scotia
Background
Neurological diseases (including traumatic brain injury) identified as a Canadian priority
Development of Canadian surveillance programs
Traumatic Brain Injury (TBI)
A bump, blow or jolt to the head, or a penetrating injury that disrupts the normal function of the brain.
Alteration in brain function manifested as confusion, altered level of consciousness, seizure, coma, or focal sensory or motor neurologic deficit resulting from blunt or penetrating force to the head.
(Faul et al. 2010)
(Bruns et al. 2003)
TBI is further defined as
Mild Moderate Severe
What is Administrative Data?
Information collected "usually by government, for some administrative purpose (e.g., keeping track of the population eligible for certain benefits, paying doctors or hospitals), but not primarily for research or surveillance purposes" (Spasoff, 1999)
Often used for research, but data not collected with this in mind
International Classification of Disease
Diagnoses are captured using International Classification of Disease (ICD) Codes ICD-9-CM ICD-10-CA
Validation of Case Definitions
Are the conditions captured in administrative data actually the conditions being experienced by the patient
Validation involves comparing administrative data codes to coding seen in another system Medical
Records Trauma Registry Et cetera.
Objective
To conduct a systematic review of published studies that have assessed the validity of traumatic brain injury (TBI) coding in administrative databases
Approach
Medline (1950 – December 2010) Embase (1980 – December 2010)
Search Strategy
Terms Administrative data, hospital discharge data, ICD-9, ICD-10, medical record, health information, surveillance, physician claims, claims, hospital discharge, coding, codes, validity, validation, case definition, algorithm, agreement, accuracy, sensitivity, specificity, positive predictive value, negative predictive value.
Combined with the MESH term and keyword for brain injuries.
Methods
Standard systematic review methodology was used
Inclusion Criteria Studies
validating TBI International Classification of Disease (ICD) 9 or 10 coding were included
Sensitivity
(Sn), Specificity (Sp), Positive Predictive Value (PPV) or Negative Predictive Value (NPV) had to be reported
Results 375 abstracts reviewed from Embase and Medline 91 duplicates, 284 abstracts left
17 abstracts selected for full text review 3 articles met all eligibility criteria
Results
All 3 articles chosen were based on American data 1.
Addressed ICD-9 and ICD-10 coding validity in vital statistics data
2.
Addressed ICD-9 coding validity in emergency department and hospital data
3.
Addressed ICD-9 coding validity in hospital discharge and trauma registry data
Results Author
Admin Data
Rodriguez (2006)
Oklahoma’s vital statistics multiplecause-of-death database (ICD-10)
Bazarian (2006)
Emergency department and hospital charts, Rochester, NY
Sn
Sp
PPV
NPV
78%
-
98%
-
45.9%
97.8%
23.7%
99.2%
Results Author Shore (2005)
Admin Data Maryland Hospital Discharge (MHD) and Maryland Trauma Registry (MTR)
PPV MHD and MTR Skull Fracture MHD Skull Fracture
MTR Skull Fracture MHD and MTR Intracranial Lesion MHD Intracranial Lesion MTR Intracranial Lesion
72.1% 71.2% 63.8%
89.5% 92.0% 88.1%
Conclusions
Validity of administrative data for identifying traumatic brain injury varies significantly
TBI ICD codes not validated in Canada
Traumatic brain injury ICD coding and case definitions should be validated in administrative databases prior to their use in health research
Future Directions
Validate pediatric TBI coding in Alberta administrative data
Develop a validated case definition that will be used for health services and outcomes research in children
Acknowledgements