{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T19:23:34Z","timestamp":1764617014040,"version":"3.46.0"},"reference-count":16,"publisher":"BMJ","funder":[{"name":"Injury and Violence Prevention Branch of NC Division of Public Health","award":["Contract Number 46745"],"award-info":[{"award-number":["Contract Number 46745"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2025,11,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code S09.90 (\u2018unspecified injury of head\u2019) is frequently used in emergency departments (EDs) but excluded from the Centers for Disease Control and Prevention (CDC)\u2019s standard traumatic brain injury (TBI) surveillance definition due to its non-specific nature. This study identifies patient-level and ED-level factors associated with the use of S09.90 and examines whether the relationship between age and S09.90 coding varies by injury severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of 2022\u20132023 TBI-related ED visits in North Carolina (NC) was conducted using data from the NC Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). TBI-related ED visits were identified based on ICD-10-CM codes, including those with and without S09.90. Injury severity was defined using patient disposition. Bivariate and multivariable logistic regressions identified predictors of S09.90 coding, and an interaction term between age and injury severity assessed modification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 229 516 TBI-related ED visits, 80.5% (n=1\u200984\u2009671) were coded with S09.90. S09.90 coding was more likely among older adults (65+years; adjusted OR (aOR)=1.68, 95%\u2009CI 1.57 to 1.79) and children (0\u201314 years; aOR=1.60, 95%\u2009CI 1.50 to 1.70) compared with working-age adults, but only among non-severe injuries. For severe injuries, children were less likely to be coded with S09.90 (aOR=0.79, 95%\u2009CI 0.68 to 0.91). S09.90 use was also associated with female patients and absence of comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusions<\/jats:title>\n                    <jats:p>Findings underscore the need for improved diagnostic specificity and consideration of S09.90 use in TBI surveillance to avoid underestimating TBI burden in specific populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/ip-2025-045965","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T18:20:15Z","timestamp":1764613215000},"page":"ip-2025-045965","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Patient-level predictors of unspecified head injury coding in traumatic brain injury-related population-based emergency department visits"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1133-7445","authenticated-orcid":false,"given":"Yuni","family":"Tang","sequence":"first","affiliation":[{"name":"Highway Safety Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0097-6631","authenticated-orcid":false,"given":"Lucas M","family":"Neuroth","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Waller","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2330-2645","authenticated-orcid":false,"given":"Katherine J","family":"Harmon","sequence":"additional","affiliation":[{"name":"Highway Safety Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"},{"name":"Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"2025120110200796000_ip-2025-045965v1.1","doi-asserted-by":"crossref","DOI":"10.1186\/s40621-021-00308-y","article-title":"Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury","volume":"8","author":"De Crescenzo","year":"2021","journal-title":"Inj Epidemiol"},{"key":"2025120110200796000_ip-2025-045965v1.2","unstructured":"Centers for medicare & medicaid services . In: ICD-10. Baltimore, MD: Centers for Medicare & Medicaid Services, Available: https:\/\/www.cms.gov\/Medicare\/Coding\/ICD10"},{"key":"2025120110200796000_ip-2025-045965v1.3","first-page":"1","article-title":"Proposed Framework for Presenting Injury Data Using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Diagnosis Codes","volume":"2016","author":"Hedegaard","year":"2016","journal-title":"Natl Health Stat Report"},{"key":"2025120110200796000_ip-2025-045965v1.4","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2019-043517"},{"key":"2025120110200796000_ip-2025-045965v1.5","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/PHH.0000000000002003","article-title":"Medical Coders\u2019 Use of the ICD-10-CM \u201cUnspecified\u201d Codes for Head and Brain Injury in Emergency Department Settings","volume":"31","author":"Wharton","year":"2025","journal-title":"J Public Health Manag Pract"},{"key":"2025120110200796000_ip-2025-045965v1.6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/PHH.0000000000002012","article-title":"Improving ICD Coding in the Emergency Department: Factors Related to Use of \u201cUnspecified\u201d Codes for Head and Brain Injury","volume":"31","author":"Wharton","year":"2025","journal-title":"J Public Health Manag Pract"},{"key":"2025120110200796000_ip-2025-045965v1.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12982-015-0031-x","article-title":"Children and youth with \u201cunspecified injury to the head\u201d: implications for traumatic brain injury research and surveillance","volume":"12","author":"Chan","year":"2015","journal-title":"Emerg Themes Epidemiol"},{"key":"2025120110200796000_ip-2025-045965v1.8","doi-asserted-by":"publisher","DOI":"10.1197\/j.aem.2005.07.038"},{"key":"2025120110200796000_ip-2025-045965v1.9","doi-asserted-by":"publisher","DOI":"10.1080\/02699050400013568"},{"key":"2025120110200796000_ip-2025-045965v1.10","unstructured":"NC department of health and human services . In: Traumatic Brain Injuries in North Carolina, 2023. NC Division of Public Health, 2025."},{"key":"2025120110200796000_ip-2025-045965v1.11","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.annepidem.2025.09.017","article-title":"Implications of case definition selection on traumatic brain injury trends: A controlled interrupted time-series analysis of North Carolina emergency department data","volume":"111","author":"Neuroth","year":"2025","journal-title":"Ann Epidemiol"},{"key":"2025120110200796000_ip-2025-045965v1.12","first-page":"188","article-title":"Charlson Comorbidity Index: ICD-9 Update and ICD-10 Translation","volume":"12","author":"Glasheen","year":"2019","journal-title":"Am Health Drug Benefits"},{"key":"2025120110200796000_ip-2025-045965v1.13","first-page":"1","article-title":"The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) External Cause-of-injury Framework for Categorizing Mechanism and Intent of Injury","volume":"2019","author":"Hedegaard","year":"2019","journal-title":"Natl Health Stat Report"},{"key":"2025120110200796000_ip-2025-045965v1.14","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1017\/cem.2018.17","article-title":"Characteristics and outcomes of older emergency department patients assigned a low acuity triage score","volume":"20","author":"Hendin","year":"2018","journal-title":"CJEM"},{"key":"2025120110200796000_ip-2025-045965v1.15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0175868","article-title":"Predictors of falls and mortality among elderly adults with traumatic brain injury: A nationwide, population-based study","volume":"12","author":"Fu","year":"2017","journal-title":"PLoS One"},{"key":"2025120110200796000_ip-2025-045965v1.16","doi-asserted-by":"publisher","DOI":"10.15585\/MMWR.MM7235A1"}],"container-title":["Injury Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ip-2025-045965","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T18:20:17Z","timestamp":1764613217000},"score":1,"resource":{"primary":{"URL":"https:\/\/injuryprevention.bmj.com\/lookup\/doi\/10.1136\/ip-2025-045965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":16,"alternative-id":["10.1136\/ip-2025-045965"],"URL":"https:\/\/doi.org\/10.1136\/ip-2025-045965","relation":{},"ISSN":["1353-8047","1475-5785"],"issn-type":[{"value":"1353-8047","type":"print"},{"value":"1475-5785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}