Advertisement

Surveillance of concussion-related injuries using electronic medical records from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN): a proof-of-concept

  • Felix Bang
  • Behrouz Ehsani
  • Steven McFaullEmail author
  • Vicky C. Chang
  • John Queenan
  • Richard Birtwhistle
  • Minh T. Do
Quantitative Research

Abstract

Introduction

Previous studies on traumatic brain injury trends in Canada have been restricted to hospitalization and emergency department visit data. However, many concussion patients may present first, or only, to family physicians. Therefore, the true burden of concussion in Canada is likely underestimated. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) collects information electronically from family physicians across Canada and can potentially be used for concussion surveillance. The objective of this study is to explore the feasibility of using data collated from CPCSSN for concussion surveillance purposes and examine trends over time.

Methods

Electronic medical records housed by CPCSSN from 2010 to 2016 were analyzed. Case ascertainment was determined through a combination of International Classification of Diseases, Ninth Revision codes. Binomial regression models were used to calculate the prevalence ratio (PR) of concussion by age, sex, deprivation indices, body mass index, and comorbid conditions.

Results

Concussion prevalence rates increased from 2010 to 2016 (p < 0.001). Based on 2016 data, males had a higher prevalence of concussion compared with females (PR = 1.09; 95% CI 1.02, 1.18), and those aged 10–14 (PR = 8.52; 95% confidence interval [CI] 6.34, 11.44) and 15–19 (PR = 7.75; 95% CI 5.84, 10.28) had higher prevalence of concussion compared with those aged 0–4 years.

Conclusion

This pilot study demonstrates the feasibility of using the CPCSSN system for surveillance of concussion in the Canadian population. The initial findings on prevalence are in agreement with previous studies that have used hospitalization or emergency department data.

Keywords

Concussion Mild traumatic brain injury Injury Electronic medical records ICD coding classification Surveillance 

Résumé

Objectifs

Les études menées précédemment sur les tendances relatives aux traumatismes crâniens au Canada se limitent aux données sur les hospitalisations et les visites aux services des urgences. Or, dans de nombreux cas, les patients victimes d’une commotion cérébrale consultent d’abord (ou uniquement) leur médecin de famille. Par conséquent, le fardeau réel des commotions cérébrales au Canada est probablement sous-estimé. Le Réseau canadien de surveillance sentinelle en soins primaires (RCSSSP), qui recueille par voie électronique des données auprès des médecins de famille de partout au Canada, pourrait servir à assurer la surveillance des commotions cérébrales. La présente étude vise à évaluer la faisabilité de l’utilisation des données issues du RCSSSP aux fins de la surveillance des commotions cérébrales et à examiner les tendances au fil du temps.

Méthodes

Nous avons analysé les dossiers médicaux électroniques de 2010 à 2016 conservés par le RCSSSP. Pour les besoins de la détermination des cas, nous avons eu recours à une combinaison de codes de la Classification internationale des maladies, neuvième révision (CIM-9). Nous avons utilisé des modèles de régression binomiale pour calculer le taux de prévalence (TP) des commotions cérébrales selon l’âge, le sexe, les indices de défavorisation, l’indice de masse corporelle et la comorbidité.

Résultats

Les taux de prévalence des commotions cérébrales ont augmenté de 2010 à 2016 (p < 0,001). Selon les données de 2016, la prévalence des commotions cérébrales était plus élevée chez les hommes que chez les femmes (TP = 1,09; intervalle de confiance [IC] à 95 % : 1,02 à 1,18); de même, les groupes des 10 à 14 ans (TP = 8,52; IC à 95 % : 6,34 à 11,44) et des 15 à 19 ans (TP = 7,75; IC à 95 % : 5,84 à 10,28) présentaient des taux de prévalence des commotions cérébrales plus élevés que le groupe des 0 à 4 ans.

Conclusion

La présente étude pilote démontre la faisabilité de l’utilisation du système du RCSSSP aux fins de la surveillance des commotions cérébrales dans la population canadienne. Les résultats initiaux sur le plan de la prévalence concordent avec les résultats des études antérieures fondées sur les données relatives aux hospitalisations ou aux visites aux services des urgences.

Mots-clés

Commotion cérébrale Traumatisme crânien léger Blessure Dossiers médicaux électroniques Classification et codage de la CIM Surveillance 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Bazarian, J. J., Veazie, P., Mookerjee, S., & Lerner, E. B. (2006). Accuracy of mild traumatic brain injury case ascertainment using ICD-9 codes. Academic Emergency Medicine, 13(1), 31–38.CrossRefGoogle Scholar
  2. Canadian Heritage. (2013). Sport participation 2010. Ottawa (ON): Canadian Heritage.Google Scholar
  3. Canadian Institute for Health Information. (2006). Head injuries in Canada: a decade of change (1994-1995 to 2003-2004). Canadian Institute for Health Information.Google Scholar
  4. Cancelliere, C., Coronado, V. G., Taylor, C. A., & Xu, L. (2017). Epidemiology of isolated versus nonisolated mild traumatic brain injury treated in emergency departments in the United States, 2006-2012: Sociodemographic Characteristics. The Journal of Head Trauma Rehabilitation, 32(4), E37–E46.CrossRefGoogle Scholar
  5. Colantonio, A., Croxford, R., Farooq, S., Laporte, A., & Coyte, P. C. (2009). Trends in hospitalization associated with traumatic brain injury in a publicly insured population, 1992-2002. The Journal of Trauma, 66(1), 179–183.  https://doi.org/10.1097/TA.0b013e3181715d66.CrossRefPubMedGoogle Scholar
  6. Colantonio, A., Mroczek, D., Patel, J., Lewko, J., Fergenbaum, J., & Brison, R. (2010). Examining occupational traumatic brain injury in Ontario. Canadian Journal of Public Health. Revue Canadienne de Sante Publique, S58–S62.Google Scholar
  7. Fu, T. S., Jing, R., McFaull, S. R., & Cusimano, M. D. (2016). Health & economic burden of traumatic brain injury in the Emergency Department. Canadian Journal of Neurological Sciences, 43(2), 238–247.CrossRefGoogle Scholar
  8. Fu, W. W., Fu, T. S., Jing, R., McFaull, S. R., & Cusimano, M. D. (2017). Predictors of falls and mortality among elderly adults with traumatic brain injury: a nationwide, population-based study. PLoS ONE, 12(4), e0175868.CrossRefGoogle Scholar
  9. Garies, S., Birtwhistle, R., Drummond, N., Queenan, J., & Williamson, T. (2017). Data resource profile: national electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). International Journal of Epidemiology, 46(4), 1091–1092.  https://doi.org/10.1093/ije/dyw248.CrossRefPubMedGoogle Scholar
  10. Health Canada. (2003). Canadian guidelines for body weight classification in adults. Ottawa: Minister of Public Works and Government Services Canada.Google Scholar
  11. Institut national de santé publique du Québec (INSPQ). (2016). Index of material and social deprivation compiled by the Bureau d’information et d’études en santé des populations (BIESP).Google Scholar
  12. Ivins, B. J. (2010). Hospitalization associated with traumatic brain injury in the active duty US Army: 2000–2006. NeuroRehabilitation, 26(3), 199–212.PubMedGoogle Scholar
  13. Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., et al. (2002). 2000 CDC growth charts for the United States: methods and development. Vital and Health Statistics. Series 11, Data from the National Health Survey, (246)(246)1–190.Google Scholar
  14. Laker, S. R. (2011). Epidemiology of concussion and mild traumatic brain injury. PM&R, 3(10), S354–S358.CrossRefGoogle Scholar
  15. Manitoba Centre for Health Policy and Evaluation, & Menec, V (2000). Defining practice populations for primary care: methods and issues. Manitoba Centre for Health Policy and Evaluation, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg.Google Scholar
  16. McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvorak, J., Echemendia, R. J., et al. (2013). Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine, 47(5), 250–258.  https://doi.org/10.1136/bjsports-2013-092313.CrossRefPubMedGoogle Scholar
  17. Ng, R., Maxwell, C. J., Yates, E. A., Nylen, K., Antflick, J., Jetté, N., & Bronskill, S. E. (2015). Brain disorders in Ontario: prevalence, incidence and costs from Health Administrative Data. Toronto: Institute for Clinical Evaluative Sciences.Google Scholar
  18. Nguyen, R., Fiest, K. M., McChesney, J., Kwon, C.-S., Jette, N., Frolkis, A. D., et al. (2016). The international incidence of traumatic brain injury: a systematic review and meta-analysis. Canadian Journal of Neurological Sciences, 43(6), 774–785.CrossRefGoogle Scholar
  19. Ontario Neurotrauma Foundation. (2013). Guidelines for concussion/mild traumatic brain injury & persistent symptoms: for adults (18+ years of age) (2nd ed.). [S.l.]: Canadian Electronic Library. http://myaccess.library.utoronto.ca/login?url=http://books.scholarsportal.info/viewdoc.html?id=/ebooks/ebooks1/gibson_chrc/2014-01-14/1/10785037.
  20. Public Health Agency of Canada. (2014). Mapping connections: an understanding of neurological conditions in Canada. Public Health Agency of Canada. http://myaccess.library.utoronto.ca/login?url=http://site.ebrary.com/lib/utoronto/Top?id=10957224.
  21. Queenan, J. A., Williamson, T., Khan, S., Drummond, N., Garies, S., Morkem, R., & Birtwhistle, R. (2016). Representativeness of patients and providers in the Canadian Primary Care Sentinel Surveillance Network: a cross-sectional study. CMAJ Open, 4(1), E28–E32.  https://doi.org/10.9778/cmajo.20140128.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Rao, D. P., McFaull, S., Thompson, W., & Jayaraman, G. C. (2018). At-a-glance - traumatic brain injury management in Canada: changing patterns of care. Health Promotion and Chronic Disease Prevention in Canada : Research, Policy and Practice, 38(3), 147–150.  https://doi.org/10.24095/hpcdp.38.3.05.CrossRefGoogle Scholar
  23. Ryu, W. H. A., Feinstein, A., Colantonio, A., Streiner, D. L., & Dawson, D. R. (2009). Early identification and incidence of mild TBI in Ontario. Canadian Journal of Neurological Sciences/Journal Canadien des Sciences Neurologiques, 36(4), 429–435.CrossRefGoogle Scholar
  24. Shore, A. D., Mccarthy, M. L., Serpi, T., & Gertner, M. (2005). Validity of administrative data for characterizing traumatic brain injury-related hospitalizations. Brain Injury, 19(8), 613–621.CrossRefGoogle Scholar
  25. Stewart, T. C., Gilliland, J., & Fraser, D. D. (2014). An epidemiologic profile of pediatric concussions: identifying urban and rural differences. The Journal of Trauma and Acute Care Surgery, 76(3), 736–742.  https://doi.org/10.1097/TA.0b013e3182aafdf5.CrossRefPubMedGoogle Scholar
  26. Taylor, C. A. (2017). Traumatic brain injury–related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR. Surveillance Summaries, 66.Google Scholar
  27. Thompson, H. J., McCormick, W. C., & Kagan, S. H. (2006). Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. Journal of the American Geriatrics Society, 54(10), 1590–1595.CrossRefGoogle Scholar
  28. Turner, C., & McClure, R. (2003). Age and gender differences in risk-taking behaviour as an explanation for high incidence of motor vehicle crashes as a driver in young males. Injury Control and Safety Promotion, 10(3), 123–130.CrossRefGoogle Scholar
  29. Wiebe, D. J., Comstock, R. D., & Nance, M. L. (2011). Concussion research: a public health priority. Injury Prevention : Journal of the International Society for Child and Adolescent Injury Prevention, 17(1), 69–70.  https://doi.org/10.1136/ip.2010.031211.CrossRefGoogle Scholar
  30. Winqvist, S., Lehtilahti, M., Jokelainen, J., Luukinen, H., & Hillbom, M. (2007). Traumatic brain injuries in children and young adults: a birth cohort study from northern Finland. Neuroepidemiology, 29(1–2), 136–142.CrossRefGoogle Scholar
  31. Zemek, R. L., Grool, A. M., Duque, D. R., DeMatteo, C., Rothman, L., Benchimol, E. I., et al. (2017). Annual and seasonal trends in ambulatory visits for pediatric concussion in Ontario between 2003 and 2013. The Journal of Pediatrics, 181, 222–228.e2.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2019

Authors and Affiliations

  • Felix Bang
    • 1
    • 2
  • Behrouz Ehsani
    • 3
  • Steven McFaull
    • 2
    Email author
  • Vicky C. Chang
    • 1
  • John Queenan
    • 3
  • Richard Birtwhistle
    • 3
  • Minh T. Do
    • 1
    • 2
    • 4
  1. 1.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  2. 2.Centre for Surveillance and Applied Research, Injury and Healthy Living UnitPublic Health Agency of CanadaOttawaCanada
  3. 3.Department of Family MedicineQueen’s UniversityKingstonCanada
  4. 4.Department of Health SciencesCarleton UniversityOttawaCanada

Personalised recommendations