Incorrect classification in articles about traumatic brain injuries in children with minor blunt head trauma

Letters The HVRN assembles home visiting stakeholders to set a na- tional research agenda, advance that agenda through innova- tion research methods, and translate research findings into policy and practice. 3 The HVRN identified the top 10 priorities for home visiting research with input from nearly 1800 individuals. 4 Now, the HVRN is building the Home Visiting Ap- plied Research Collaborative, a national practice-based re- search network of local home visiting programs to conduct field- initiated studies to address the research agenda’s priorities. We need to learn what works best for which families and under what circumstances and to translate this efficiently to policy and practice. The MIECHV Program’s state-level evalu- ative research, the Mother and Infant Home Visiting Program Evaluation, and the HVRN will substantially “clarify the evi- dence base” 1 related to home visiting investments to maxi- mize outcomes for children, families, and communities. Stake- holders are key participants in these efforts; they are eager to use results to ensure success in the adoption, adaptation, implementation, and sustainability of home visiting as part of the early childhood system of care and as part of efforts to pro- mote the foundations of health by enhancing the capacity of caregivers and communities. 5 Cynthia S. Minkovitz, MD, MPP Kay M. Gonsalves O’Neill, MSPH Anne K. Duggan, ScD Author Affiliations: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Corresponding Author: Cynthia S. Minkovitz, MD, MPP, Departments of Population, Family and Reproductive Health, and Pediatrics, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4636, Baltimore, MD 21205 (cminkovi@jhsph.edu). Conflict of Interest Disclosures: None reported. Funding/Support: Each of the authors is funded in part through home visiting research supported by grants or subcontracts as part of the Patient Protection and Affordable Care Act. Role of the Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. 1. Shonkoff JP. Changing the narrative for early childhood investment. JAMA Pediatr. 2014;168(2):105-106. 2. Michalpoulos C, Duggan A, Knox V, et al. ACF-OPRE Reports 2011-16: Design Options for the Home Visiting Evaluation: Draft Final Report. Washington, DC: US Dept of Health & Human Services; 2011. 3. Duggan A, Minkovitz CS, Chaffin M, et al. Creating a national home visiting research network. Pediatrics. 2013;132(suppl 2):S82-S89. 4. Home Visiting Research Network. Home visiting research agenda. http://www.hvrn.org/research-agenda.html. Accessed December 30, 2013. 5. Mistry KB, Minkovitz CS, Riley AW, et al. A new framework for childhood health promotion: the role of policies and programs in building capacity and foundations of early childhood health. Am J Public Health. 2012;102(9):1688-1696. Incorrect Classification in Articles About Traumatic Brain Injuries in Children With Minor Blunt Head Trauma To the Editor We are writing to make readers aware of an ana- lytic error that affected the data reported in 2 of our articles. 1,2 During recent preparation of another manuscript based on the same data, we discovered an error in construction of the final jamapediatrics.com analytic database for the entire cohort (an erroneous SQL [Structured Query Language] join statement) that led to the incorrect classification of the mechanism of injury as moder- ate, rather than severe, for 394 children in our cohort of 42 412 patients. Most of the erroneous classifications were among chil- dren aged 2 years or older. The first article affected by this erroneous classification was titled “Prevalence of Clinically Important Traumatic Brain In- juries in Children With Minor Blunt Head Trauma and Isolated Severe Injury Mechanisms.” 1 We have carefully examined the effects of this error on the entire published analysis. As previ- ously noted, the number of children with severe injury mecha- nism increased by 394, and the number of children with iso- lated severe injury mechanism increased from 3302 to 3630 as a result. These increased numbers led to numerous modifica- tions to data points in the article. However, the most impor- tant data points in the report are only slightly affected. The over- all incidence of severe injury mechanism increases by only a single percentage point in this population (from 14% to 15%) and the rates of clinically important traumatic brain injuries asso- ciated with isolated severe injury mechanism remain low, de- creasing by one-tenth of 1% among older children (from 0.6% to 0.5% for isolated severe mechanism and no other Pediatric Emergency Care Applied Research Network predictors and from 0.3% to 0.2% for isolated severe mechanism and no other pre- dictors in the expanded definition), with no change among younger children from the published report. The second article affected by the erroneous classifica- tion was titled “Cranial Computed Tomography Use Among Children With Minor Blunt Head Trauma: Association With Race/Ethnicity.” 2 Again, an erroneous SQL join statement led to the incorrect classification of the mechanism of injury as moderate, rather than severe, for 394 children in our cohort of 42 412 patients. This led to minor effects on the reported tabular data (Tables 1, 2, and 3), as well as minor differences in reported odds ratios/confidence intervals for association of black non-Hispanic or Hispanic race/ethnicity with cranial com- puted tomography in the emergency department (these data are reported in the abstract and the Results section of the text). We regret these errors but also believe unequivocally that the key findings and conclusions of the published papers firmly stand. The articles have been corrected and correction no- tices published. Nathan Kuppermann, MD, MPH JoAnne E. Natale, MD, PhD Lise E. Nigrovic, MD, MPH Author Affiliations: Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento (Kuppermann); Department of Pediatrics, University of California, Davis School of Medicine, Sacramento (Kuppermann, Natale); Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts (Nigrovic). Corresponding Author: Nathan Kuppermann, MD, MPH, Departments of Emergency Medicine and Pediatrics, University of California, Davis Medical Center, 2315 Stockton Blvd, PSSB Bldg, Suite 2100, PSSB 2100, Sacramento, CA 95817 (nkuppermann@ucdavis.edu). Published Online: May 19, 2014. doi:10.1001/jamapediatrics.2014.651. Conflict of Interest Disclosures: None reported. JAMA Pediatrics June 2014 Volume 168, Number 6 Copyright 2014 American Medical Association. All rights reserved.