Case ascertainment in pediatric traumatic brain injury: challenges in using the NEISS.
Case ascertainment in pediatric traumatic brain injury: challenges in using the NEISS.
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儿科创伤性脑损伤的病例查明：使用 NEISS 的挑战。
DOI：
10.1080/02699050701311034
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发表时间：
2007
期刊：
影响因子：
1.9
通讯作者：
Kelleher,Kelly
中科院分区：
文献类型：
--
作者：
Xiang,Huiyun;Sinclair,SaraA;Yu,Songlin;Smith,GaryA;Kelleher,Kelly
主要目的：评估美国国家电子损伤监测系统(NEISS)中轻型创伤性脑损伤(TBI)病例的确定情况。研究设计：对NEISS病例样本进行分析。两名训练有素的研究人员独立审查了基于国际疾病分类第9版临床修改(ICD-9-CM)的诊断代码。评价两种NEISS脑损伤定义的敏感性和特异性，并计算Kappa系数，评价NEISS脑损伤定义与基于ICD-9-CM的标准脑损伤定义的一致性。结果：我们的抽样程序共提供了1018例NEISS病例，其中880例为损伤病例，138例为非损伤病例。其中54例按ICD-9-CM诊断标准判定为轻型颅脑损伤。与非颅脑损伤病例相比，1岁以下婴儿的比例(33.3%)明显高于非颅脑损伤病例(15.4%)，且更有可能住院治疗。如果采用NEISS1定义(诊断代码52表示脑震荡)，则敏感性仅为38.9%(95%可信区间(CI) = 为25.9-51.9%)。然而，如果使用NEISS2(脑震荡的诊断代码52或内脏损伤的诊断代码62，而头部是受影响的身体部位)来识别脑外伤，则敏感性显著增加到79.6%(95%CI = 为68.9-90.4%)。NEISS定义1与ICD9-CM系统总体一致性的Kappa系数为0.528(95%CI = 0.393~0.664)，NEISS定义2为0.807(95%CI = 0.723~0.892)。需要进一步的研究工作来完善NEISS中的脑损伤病例确证。
Primary objective: To evaluate mild traumatic brain injury (TBI) case ascertainment in the US National Electronic Injury Surveillance System (NEISS).Research design: A sample of NEISS injury cases was analyzed. Two trained researchers independently reviewed diagnostic codes based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). The sensitivity and specificity of two NEISS TBI definitions were evaluated, and Kappa coefficients were calculated to evaluate the agreement between NEISS TBI definitions and the standard TBI definition based on the ICD-9-CM.Results: Our sampling procedures provided a total of 1,018 NEISS cases, of which 880 were injury cases and 138 were non-injury cases. Out of the injury cases, 54 cases were defined as mild TBI cases based on the ICD-9-CM diagnosis codes. Compared with non-TBI injury cases, a significantly higher percentage of TBI cases (33.3% versus 15.4%) were infants less than 1 year old and TBI cases were more likely to be admitted for hospitalization. If TBI was identified using NEISS definition 1 (diagnosis code 52 for ‘concussion’), the sensitivity was only 38.9% (95% confidence intervals (CI) = 25.9–51.9%). However, if TBI was identified using NEISS definition 2 (diagnosis code 52 for ‘concussion’ or 62 for ‘internal organ injury’ and ‘head’ was the affected body part), the sensitivity increased dramatically to 79.6% (95% CI = 68.9–90.4%). The Kappa coefficient for overall agreement between the NEISS and ICD-9-CM system was 0.528 (95% CI = 0.393–0.664) for NEISS definition 1 and 0.807 (95% CI = 0.723–0.892) for NEISS definition 2.Conclusions: The current approach of pediatric TBI case ascertainment in the NEISS faces some challenges in identifying mild TBI. Future research efforts are needed to refine TBI case ascertainment in the NEISS.