Table 5.
Investigation of codes to be included for the definition of traumatic brain injuries for surveillance in Ontario.
| Block of Code | Consensus | Sources of Evidence | Evidence |
|---|---|---|---|
| S00 - Superficial injury to head | Only used to define head injury | -- | -- |
| S01 - Open wound to head | Recommended by CDC, WHO, Fingerhut, used by those defining head injury | Evidence from Fingerhut paper and discussion with CDC. | Used by coroners to code those with gunshot wound to head [18]. |
| S02 - Facial Fractures | At least one S02 code included by 12 out of 16 papers. | Papers on correlation between specific facial fractures and brain injuries. | Retrospective data from a trauma database found that in blunt trauma, more people had TBI among those with facial fracture compared to those without TBI (p < 0.001) [22] Those with facial fractures have a higher incidence of severe head injury and score lower on the Functional Independence Measure (FIM) on discharge compared to those with no facial fracture [22] The odds ratio of a brain injury was 24.4 for an orbital fracture, and 135 for a maxillary fracture compared to those without a brain injury [20] 70.2% of those with an orbital facial fracture and 75.5% of those with a zyoma fracture sustained a brain injury in a study of those hospitalized from a motorcycle accident [21] |
| S03-S05, S08 -- Dislocation, sprain and strain of joints and ligaments of head; injury to cranial nerves; injury to eye and orbit; Traumatic amputation of part of head | Only used to define head injury | -- | -- |
| S07 - Crush injuries to the head | 9 out of 17 papers used at least one S07 code | Papers on correlation between crush injuries and brain injuries. Only case studies were found. | A case study of eight children who suffered crush head injuries all suffered from identifiable cerebral trauma [23]. Another case study of seven children found that they all experiencing multiple fractures of the head, including facial, orbits, frontal, sphenoid, ethmoid, occipital, and temporal bones [38]. |
| S09 - multiple and unspecified injuries to the head | 11 out of 17 papers used at least one S09 code | Data from ICD-9 studies on the inclusion of unspecified codes and data from ABI dataset on the specificity and sensitivity of codes used. | The ABI Dataset found that there is at least a 3 fold increase in numbers of cases by adding S09 codes [12]. The CDC found that used 959.01 in ICD-9 the use of this code has grown steadily and may lead to lower specificity of the code (positive predictive value of 20%) [26] |