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Applying a Novel Diagnostic Code System to Identify Postconcussive Symptom Subgroups Among Service Members With Mild
Adam R Kinney1, Treven C Pickett, Amy O Bowles
1Author Affiliations:VA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO (Kinney, Forster, Adams, and Smith); University of Colorado, Anschutz Medical Campus, Aurora, CO (Kinney, Forster, Baugh, Smith, and Brenner); National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD (Pickett, DeGraba, and Lyle); Brain Injury Rehabilitation Service, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft Sam Houston, Texas (Bowles); Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA (Adams); VA Brain Health Coordinating Center, VA Rocky Mountain Regional Medical Center, Aurora, CO (Brenner); Program Executive Office, Defense Healthcare Management Systems, Rosslyn, Virginia (Caban, Tung, and Wal); Department of Rehabilitation, Uniform Services University of the Health Sciences, Bethesda, MD (Pickett).
A novel code set identified five distinct postconcussive symptom (PCS) subgroups in service members with mild traumatic brain injury (mTBI). This aids in understanding varied PCS patterns for targeted interventions.
Area of Science:
- Neuroscience
- Public Health
- Military Medicine
Background:
- Mild traumatic brain injury (mTBI) is prevalent in service members.
- Postconcussive symptoms (PCS) present diverse challenges.
- Identifying distinct PCS patterns is crucial for effective care.
Purpose of the Study:
- Develop a novel code set for identifying PCS from medical records.
- Apply this code set to a large cohort of service members with mTBI.
- Identify distinct subgroups based on PCS patterns.
Main Methods:
- Developed a PCS code set using ICD-9/10 codes based on Neurobehavioral Symptom Inventory categories.
- Utilized latent class analysis (LCA) with cross-validation.
- Analyzed medical records from a population-based sample of 148,293 service members (2002-2021).
Main Results:
- A code set of 20 PCS symptoms was finalized.
- Latent class analysis identified 5 distinct subgroups: Minimal (59%), Headache (16%), Mood-Behavioral (15%), Headache-Sleep (6%), and Headache-Mood-Sleep (5%).
Conclusions:
- A novel PCS code set effectively identified 5 clinically meaningful subgroups in service members with mTBI.
- These subgroups offer a person-centered understanding of PCS.
- Findings support targeted interventions, policies, and prognostication for TBI care.
