Common Data Elements: Critical Assessment of Harmonization between Current Multi-Center Traumatic Brain Injury Studies

Standardization and harmonization of data collection in studies on traumatic brain injury (TBI) is of paramount importance for meta-analyses across studies. Nearly 10 years ago, the first set of Common Data Elements for TBI (TBI-CDEs v1) were introduced to achieve these goals. The TBI-CDEs version 2 were developed in 2012 to broaden the approach to all ages, injury severity, and phases of recovery. We aimed to quantify the degree of harmonization of these data elements in three large, prospective multi-center studies conducted within the International Initiative for TBI Research (InTBIR). Data variables of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI; adult and pediatric patients in Europe and Israel), Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI; adult and pediatric patients in the U.S.), and Approaches and Decisions in Acute Pediatric TBI (ADAPT; international study on severe pediatric TBI) studies were indexed and matched to the second version of the TBI CDEs. We focused on the CDE sub-categories of "Acute Hospitalized" (AH) and "Moderate/Severe TBI: Rehabilitation (Rehab). All "Core" and "Basic" level CDEs were considered. Closely related elements were reduced to one variable to prevent over-representation. Categorical elements and text elements for the same variable were likewise merged to one element for analysis. Following reduction and merging of related elements, 21 Core, 46 Basic AH, and 50 Basic Rehab elements were deemed harmonizable across studies. Gaps in global applicability were identified for four of the TBI CDEs and many of the outcome instruments, which are only available in the English language. Agreements of Core and Basic study CDEs for the AH domain with the TBI CDEs were respectively 81% and 91% for CENTER-TBI, 76% and 93% for TRACK-TBI, and 85% in ADAPT for both domains. For the domain Rehab, agreement with Basic TBI CDEs was 84% for CENTER-TBI, 94% for TRACK-TBI, and 71% for ADAPT. Non-harmonization was largely caused by absence of the elements in the studies. For elements present, the compatibility of coding with TBI CDEs was 90-99%. The degree of harmonization was greatest between CENTER-TBI and TRACK-TBI with 81-87% overlap within the TBI CDE sub-categories. The high degree of harmonization of study variables among these studies demonstrates the importance and utility of common data elements in TBI research. It also confirms the potential for future meta-analyses across these large studies, especially for CENTER TBI and TRACK TBI. The global applicability of the TBI CDEs needs to be improved for them to become a global standard for TBI research. CENTER-TBI, TRACK-TBI, and ADAPT, along with other studies within the InTBIR Initiative, provide a platform to inform further refinement and internationalization for the next version of the TBI CDEs.