Rationale for the Development of a Traumatic Brain Injury Case Definition for the Pilot National Concussion Surveillance System.
Jill Daugherty, Alexis Peterson, Dana Waltzman and 5 others
PMID 38039498WHAT IT FOUND
Traumatic brain injuries are often missed in hospital records.
A new surveillance system uses a three-tier case definition based on symptom type, number, and timing to better capture mild injuries that never reach a doctor.
Key findings
01Hospital-based surveillance misses most mild traumatic brain injuries, as many are treated outside emergency departments or not at all.
02A tiered case definition classifies injuries by certainty: Tier 3 includes immediate core symptoms like loss of consciousness, while Tier 1 includes delayed or non-specific symptoms.
03Self-report surveys are proposed as the only feasible way to get comprehensive estimates of traumatic brain injury burden.
STILL TO COME
How it was doneWhat they found
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What it does not show
This is a methodological paper describing the development of a surveillance tool, not a clinical trial or observational study of patients. The proposed case definition has not yet been validated against clinical diagnoses in this paper; it is designed for future surveillance testing. The reliance on self-report in surveillance surveys introduces potential for recall bias and inaccurate symptom reporting. The authors note that despite expert consultation, the list of signs and symptoms may not include every possible presentation of TBI.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not use this tiered case definition to diagnose individual patients in a clinic. It is a statistical tool designed for population-level surveillance surveys to estimate how many people have had a concussion, not a clinical diagnostic criteria for treating a specific person.