Validation of ICD-10-CM surveillance codes for traumatic brain injury inpatient hospitalizations.
James Warwick, Svetla Slavova, Joshua Bush and 1 others
PMID 33280404WHAT IT FOUND
Inpatient records coded for skull fractures alone often do not represent true traumatic brain injury, with a positive predictive value of 15.8%.
Records coded for intracranial injury were far more accurate, confirming TBI in 96.9% of cases when listed as the primary diagnosis.
Key findings
01Skull fracture codes without a concurrent intracranial injury code had a very low positive predictive value of 15.8% for confirming TBI.
02The intracranial injury code S06 had a high positive predictive value of 96.9% when used as the principal diagnosis.
03No patient records in the sample documented the use of a TBI-specific symptom inventory.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study relied on a single reviewer, though a trauma surgeon consulted on ambiguous cases. Assessment depended entirely on the quality of existing clinical documentation, which was often incomplete for mild TBI. The sample was limited to inpatient records from one health care system, so results may not generalize to other settings or populations. The study period was not long enough to capture rare codes included in the surveillance definition. Retrospective review cannot definitively rule out TBI if it was not documented, potentially underestimating true prevalence.
Declared interests
The study was supported by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Deafness and Other Communication Disorders (NIDCD), which are part of the National Institutes of Health (NIH).
The easy way to misread this
Do not assume that a patient with a skull fracture code has a traumatic brain injury. The study found that skull fracture codes alone had a very low positive predictive value (15.8%) for confirming TBI, meaning most patients with these codes did not have a documented brain injury.