Investigating the variability in mild traumatic brain injury definitions: a prospective cohort study

Publication date: Available online 31 January 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Louise M. Crowe, Stephen Hearps, Vicki Anderson, Meredith 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
ObjectiveTo prospectively compare the proportion of traumatic brain injuries (TBIs) that would be classified as 'mild' using different published definitions by applying published definitions of mild TBI to a large prospectively collected dataset and to examine the variability in the proportions included by various definitions. High rates of mild TBI in children makes it a major public health issue, however, there is a wide variation in how mild TBI is defined in literature and guidelines.DesignProspective observational study.SettingTen hospital emergency departments in the 'PREDICT' network based in Australia and New Zealand.ParticipantsThe sample included 11,907 children aged 3-16 years. The mean age was 8.2 years (SD = 3.9 years), 3,868 (32.5%) were female, and 7,374 (61.9%) of TBI were due to a fall. Median Glasgow Coma Score was 15.Main outcome measureWe applied 17 different definitions of mild TBI, identified through a published systematic review, to children aged 3-16 years. Adjustments and clarifications were made to some definitions. The number and percentage identified for each definition is presented.ResultsAdjustments 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.ConclusionsWhen 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.



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