Traumatic Brain Injury: The National Trauma Registry*
Einat Peles, Vita Barell, Valentina Boyko, Arnona Ziv, Giora Kaplan
Health Services Research Unit, Ministry of Health, Sheba Medical Center Tel-Hashomer
Background: Traumatic Brain Injury (TBI) has been established as a category in reporting systems. Uniform data systems case definition has been suggested for hospital discharge data surveillance systems cases based on ICD-9-CM diagnostic codes. These include fractures and specific mention of intracranial injuries such as contusion, laceration, hemorrhage, and concussion. Inspection of data from the Israel National Trauma Registry suggested that two diagnostic groups of very different severity and outcome were being unjustifiably combined.
Aim: To evaluate the validity of categorizing TBI into two discrete groups, using the presence of specific mention of intracranial injury and/or loss of consciousness for more than one hour as the definition of definite TBI. Possible TBI includes skull fractures with no mention of intracranial injury and/or concussion with no loss of consciousness.
Methods: The study population includes all traumatic injuries admitted to hospital, dying in the ER or transferred to other hospitals and recorded in the 1998 Trauma Registry in all 6 level I trauma centers in Israel and two level II centers.
Results: The significant difference in severity between groups supports the validity of sub-dividing the TBI classification into definite and possible subcategories. As a result, we obtain two different severity groups without measuring specific severity scores which are limited in the reporting system.
Conclusion: The groups were significantly different in severity, hospital resource use, immediate outcome, demographic and injury circumstances.
* Level I: Rambam, Beilinson-Schneider, Sheba, Ichilov (Tel Aviv Sourasky Medical Center), Hadassah Ein Karem and Soroka.
Level II: Hillel Yaffe and Kaplan