Ryu Won Hyung A, Feinstein Anthony, Colantonio Angela, Streiner David L, Dawson Deirdre R
Kunin-Lunenfeld Applied Research Unit, Baycrest, Toronto, Ontario, Canada.
Can J Neurol Sci. 2009 Jul;36(4):429-35. doi: 10.1017/s0317167100007745.
(1) To examine the variability in diagnosis of mild traumatic brain injury (mTBI) in primary care relative to that of an expert reviewer; and (2) to determine the incidence rate of mTBI in Ontario, Canada.
Potential mTBI cases were identified through reviewing three months of Emergency Department (ED) and Family Physician (FP) health records. Potential cases were selected from ED records using the International Classification of Disease, 9th revision, Clinical Modification and External Cause codes and from all FPs records for the time period. Documented diagnoses of mTBI were compared to expert reviewer diagnosis. Incidence of mTBI was determined using the documented diagnoses and data from hospital catchment areas and population census.
876 potential mTBI cases were identified, 25 from FP records. Key indicators of mTBI were missing on many records (e.g., 308/876 records had Glasgow Coma Scale (GCS) scores). The expert reviewer disagreed with the documented diagnosis in 380/876 cases (kappa = 0.19). The expert reviewer was more likely to give a diagnosis if the GCS was 13-14, if there was documented loss of consciousness and/or post-traumatic amnesia, and/or if there was pathology found on an acute brain scan. Calculated incidence rates of hospital-treated mTBI were 426 or 535/100,000 (expert review--hospital diagnosis). Including family physician cases increased the rate to 493 or 653/100,000.
Health record documentation of key indicators for mTBI is often lacking. Notwithstanding, some patients with mTBI appear to be missed or misdiagnosed by primary care physicians. A more comprehensive case definition resulted in estimated incidence rates higher than previous reports.
（1）研究初级保健中轻度创伤性脑损伤（mTBI）诊断相对于专家评审的变异性；（2）确定加拿大安大略省mTBI的发病率。
通过审查三个月的急诊科（ED）和家庭医生（FP）健康记录来识别潜在的mTBI病例。使用国际疾病分类第9版临床修订本和外部病因编码从ED记录中选择潜在病例，并从该时间段内所有FP记录中选择。将记录的mTBI诊断与专家评审诊断进行比较。使用记录的诊断以及医院服务区和人口普查数据确定mTBI的发病率。
共识别出876例潜在的mTBI病例，其中25例来自FP记录。许多记录中缺少mTBI的关键指标（例如，308/876份记录有格拉斯哥昏迷量表（GCS）评分）。专家评审在380/876例病例中不同意记录的诊断（kappa = 0.19）。如果GCS为13 - 14、有记录的意识丧失和/或创伤后遗忘，和/或急性脑部扫描发现病变，专家评审更有可能做出诊断。计算得出的医院治疗的mTBI发病率为426或535/10万（专家评审 - 医院诊断）。包括家庭医生病例后，发病率增至493或653/10万。
mTBI关键指标的健康记录文档常常缺失。尽管如此，一些mTBI患者似乎被初级保健医生漏诊或误诊。更全面的病例定义导致估计发病率高于先前报告。
