6 - Characterization of mild Traumatic Brain Injury (mTBI) cohort with photophobia from the Defense and Veterans Eye and Vision Injury Registry (DVEIVR)
Background: Traumatic Brain Injury (TBI) is a significant public health problem which is often associated with physical, sensory, and cognitive symptoms and dysfunctions, including those affecting the visual system. Photophobia, or light sensitivity, is a frequent symptom reported by TBI patients. Since photophobia does not have a dedicated ICD code, it cannot be properly assessed using conventional electronic health data. The VCE’s Defense and Veterans Eye Injury Registry (DVEIVR) contains clinical information abstracted directly from patient records, including symptoms, such as photophobia. Utilizing the DVEIVR database, the VCE extracted and characterized the cohort of Service members (SMs) diagnosed with TBI and concomitant photophobia.
Methods: The case definition for TBI was adopted based on Traumatic Brain Injury Center of Excellence (TBICoE) criteria. A TBI photophobia cohort was defined as individuals diagnosed with documented photophobia within 15 days after TBI diagnosis. The data was de-identified and the aggregate cohort characteristics, including demographics, were extracted from DVEIVR. The frequencies of coded conditions and symptoms in this cohort were calculated using SAS. The co-occurrence analysis of the photophobia with other significant conditions/symptoms was conducted using the cooccur package in R. The effectiveness of usage of proxy ICD codes for photophobia was assessed.
Results: The VCE identified 726 mTBI patients with photophobia, accounting for 6103 abstracted encounters in DVEIVR. 83.3% of the SMs were male and 16.5% were female. The largest age group was 18-24 y/o (54%), followed by 25-34 y/o (35%) and 35-44 y/o (6%). Headaches, including migraines, were the most frequently experienced complaint in our cohort (91.6%), followed by dizziness and vertigo (52.5%) and nausea (41%). These symptoms manifested in our cohort occurred at a higher probability than by chance alone, indicating that they might be physiologically and/or functionally related to the observed photophobia. 27.13% of the SMs had at least one of the non-specific codes utilized for photophobia.
Summary: Photophobia in the mTBI SMs cohort from DVEIVR exhibited a strong association with headaches, dizziness and vertigo, and nausea. This association may signal an inter-related neurologic mechanism of this symptomatology. The usage of general codes accepted for coding for photophobia, along with other conditions, was low (less than 30%). Having a specific ICD code for photophobia will improve data recording, abstraction, and analysis.
Keywords: Defense and Veterans Eye and Vision Injury Registry; Photophobia; Service members; co-morbidities
