title: Comparison of SNOMED CT versus Medcin terminology concept coverage for mild Traumatic Brain Injury.
abstract: BACKGROUND
  Traumatic Brain Injury (TBI) is a "signature" injury of the current wars in Iraq and Afghanistan. Structured electronic data regarding TBI findings is important for research, population health and other secondary uses but requires appropriate underlying standard terminologies to ensure interoperability and reuse. Currently the U.S. Department of Veterans Affairs (VA) uses the terminology SNOMED CT and the Department of Defense (DOD) uses Medcin.
  
  
  METHODS
  We developed a comprehensive case definition of mild TBI composed of 68 clinical terms. Using automated and manual techniques, we evaluated how well the mild TBI case definition terms could be represented by SNOMED CT and Medcin, and compared the results. We performed additional analysis stratified by whether the concepts were rated by a TBI expert panel as having High, Medium, or Low importance to the definition of mild TBI.
  
  
  RESULTS
  SNOMED CT sensitivity (recall) was 90% overall for coverage of mild TBI concepts, and Medcin sensitivity was 49%, p < 0.001 (using McNemar's chi square). Positive predictive value (precision) for each was 100%. SNOMED CT outperformed Medcin for concept coverage independent of import rating by our TBI experts.
  
  
  CONCLUSIONS
  SNOMED CT was significantly better able to represent mild TBI concepts than Medcin. This finding may inform data gathering, management and sharing, and data exchange strategies between the VA and DOD for active duty soldiers and veterans with mild TBI. Since mild TBI is an important condition in the civilian population as well, the current study results may be useful also for the general medical setting.
authors.affiliation: Department of Veterans Affairs, Nashville, TN, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Montella
authors.forename: Steven H
authors.initials: SH
authors.lastname: Brown
authors.forename: Peter L
authors.initials: PL
authors.lastname: Elkin
authors.forename: James C
authors.initials: JC
authors.lastname: Jackson
authors.forename: S Trent
authors.initials: ST
authors.lastname: Rosenbloom
authors.forename: Dietlind
authors.initials: D
authors.lastname: Wahner-Roedler
authors.forename: Gail
authors.initials: G
authors.lastname: Welsh
authors.forename: Bryan
authors.initials: B
authors.lastname: Cotton
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Guillamondegui
authors.forename: Henry
authors.initials: H
authors.lastname: Lew
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Taber
authors.forename: Larry A
authors.initials: LA
authors.lastname: Tupler
authors.forename: Rodney
authors.initials: R
authors.lastname: Vanderploeg
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
mesh_terms: D001930:Brain Injuries / Q000145:classification*; D006801:Humans; D016347:Medical Records Systems, Computerized; D039061:Systematized Nomenclature of Medicine; D014481:United States; D059030:United States Department of Defense; D014493:United States Department of Veterans Affairs; D018875:Vocabulary, Controlled