Investigating the Variability in Mild Traumatic Brain Injury Definitions: A Prospective Cohort Study

Louise M Crowe; Stephen Hearps; Vicki Anderson; Meredith L Borland; Natalie Phillips; Amit Kochar; Sarah Dalton; John A Cheek; Yuri Gilhotra; Jeremy Furyk; Jocelyn Neutze; Mark D Lyttle; Silvia Bressan; Susan Donath; Charlotte Molesworth; Ed Oakley; Stuart R Dalziel; Franz E Babl

doi:10.1016/j.apmr.2017.12.026

Investigating the Variability in Mild Traumatic Brain Injury Definitions: A Prospective Cohort Study

Arch Phys Med Rehabil. 2018 Jul;99(7):1360-1369. doi: 10.1016/j.apmr.2017.12.026. Epub 2018 Jan 31.

Authors

Louise M Crowe¹, Stephen Hearps², Vicki Anderson³, Meredith L Borland⁴, Natalie Phillips⁵, Amit Kochar⁶, Sarah Dalton⁷, John A Cheek⁸, Yuri Gilhotra⁵, Jeremy Furyk⁹, Jocelyn Neutze¹⁰, Mark D Lyttle¹¹, Silvia Bressan¹², Susan Donath¹³, Charlotte Molesworth², Ed Oakley¹⁴, Stuart R Dalziel¹⁵, Franz E Babl¹⁴

Affiliations

¹ Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Melbourne School of Psychological Science, University of Melbourne, Melbourne, VIC, Australia; Psychology Department, Royal Children's Hospital, Melbourne, VIC, Australia. Electronic address: [email protected].
² Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.
³ Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Melbourne School of Psychological Science, University of Melbourne, Melbourne, VIC, Australia; Psychology Department, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
⁴ Emergency Department, Princess Margaret Hospital for Children, Perth, WA, Australia; Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, WA, Australia.
⁵ Emergency Department, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.
⁶ Emergency Department, Women's & Children's Hospital, Adelaide, SA, Australia.
⁷ Emergency Department, The Children's Hospital at Westmead, Sydney, NSW, Australia.
⁸ Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Emergency Department, Royal Children's Hospital, Melbourne, VIC, Australia; Monash Medical Centre, Melbourne, VIC, Australia.
⁹ Emergency Department, The Townsville Hospital, Townsville, QLD, Australia.
¹⁰ Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand.
¹¹ Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Bristol Royal Hospital for Children, Bristol, United Kingdom; Academic Department of Emergency Care, University of the West of England, Bristol, United Kingdom.
¹² Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Women's and Children's Health, University of Padova, Padova, Italy.
¹³ Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
¹⁴ Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Emergency Department, Royal Children's Hospital, Melbourne, VIC, Australia.
¹⁵ Starship Children's Health, Auckland, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand.

PMID: 29407521
DOI: 10.1016/j.apmr.2017.12.026

Abstract

Objective: To prospectively compare the proportion of traumatic brain injuries (TBIs) that would be classified as mild by applying different published definitions of mild TBI to a large prospectively collected dataset, and to examine the variability in the proportions included by various definitions.

Design: Prospective observational study.

Setting: Hospital emergency departments.

Participants: Children (N=11,907) aged 3 to 16 years (mean age, 8.2±3.9y). Of the participants, 3868 (32.5%) were girls, and 7374 (61.9%) of the TBIs were the result of a fall. Median Glasgow Coma Scale score was 15.

Main outcome measures: We applied 17 different definitions of mild TBI, identified through a published systematic review, to children aged 3 to 16 years. Adjustments and clarifications were made to some definitions. The number and percentage identified for each definition is presented.

Results: Adjustments had to be made to the 17 definitions to apply to the dataset: none in 7, minor to substantial in 10. The percentage classified as mild TBI across definitions varied from 7.1% (n=841) to 98.7% (n=11,756) and varied by age group.

Conclusions: When applying the 17 definitions of mild TBI to a large prospective multicenter dataset of TBI, there was wide variability in the number of cases classified. Clinicians and researchers need to be aware of this variability when examining literature concerning children with mild TBI.

Keywords: Brain injuries, traumatic; Child; Rehabilitation.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Brain Concussion / classification*
Child
Child, Preschool
Datasets as Topic
Emergency Service, Hospital / statistics & numerical data*
Female
Glasgow Coma Scale / statistics & numerical data*
Humans
Male
Prospective Studies