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Under-Reporting of Focal Brain Injuries in Emergency Department Records vs. Hospital Inpatient Records within the National Trauma Data Bank

Descriptive Note:

[Technical Report, Technical Report]

Corporate Author:

U.S. Army Combat Capabilities Development Command, U. S. Army Army Research LaboratoryMassachusetts General HospitalDenver Health and Hospital AuthorityBENNETT AEROSPACE LLC CARY NCDATA AND ANALYSIS CENTER ABERDEEN PROVING GROUND MD

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The objective of this research was to investigate the prevalence of skull fracture and focal brain FB injury between emergency department ED and hospital inpatient records HOSP of the National Trauma Databank from 2013 to 2015 to identify if there was a difference in the types of head injury HI identified and associated with fatalities. A retrospective cohort design of military-aged adults ages 1755 was used to study incidence of HI with associated FB injury andor skull fracture. Injury groups were categorized and fatalities in each group were compared to understand differences between ED and HOSP. For the subset of 1,145,575 patients with only HI, there were differences between HI of the deceased patients in ED and HOSP. The prevalence of deaths with FB injury was significantly higher in HOSP than ED P0.0001. When examining the prevalence of fatalities with skull fracture, the prevalence of skull fractures was significantly higher in HOSP versus EDP0.0398. For the population of patients that died with diagnosed FB injury, the prevalence without coexisting skull fracture was similar between ED and HOSP. However, the prevalence of ED deaths with diagnosed skull fractures without coexisting FB injury was greater than HOSP. The differences between HI from the datasets may result from different objectives and treatment capabilities between the two departments. Due to the occult nature of FB injury and diagnostic tools needed to identify it, FB injury could be underdiagnosed therefore underreported in the ED, especially in cases where brain injury is not associated with skull fractures. This study emphasizes that caution should be exercised when utilizing this dataset for HI analysis or fatality studies.


Subject Categories:

  • Medicine and Medical Research
  • Information Science

Distribution Statement:

[A, Approved For Public Release]