Objective: To evaluate modifications to a tiered priority chart review system designed to efficiently identify patients with mild traumatic brain injury (mTBI), via medical chart review, that presented to an emergency department or urgent and primary care center (ED/UPCC) for research purposes. Methods: We initially created a tiered priority chart review system and applied it to screening N=17,072 electronic ED/UPCC medical charts in study 1 (Clinicaltrials.gov ID# NCT04704037). Chief complaints with high positive predictive value (PPV) for correctly identifying possible/probable mTBI cases were moved to a higher tier and those with low positive predictive value were downgraded to create a tiered priority chart review system. This revised system was then used in a second research study (Clinicaltrials.gov ID# NCT05365776), and PPV values were calculated for the new sample (N=4,434). The original and revised tiered priority system were compared with respect to overall efficiency. Results: PPV for specific chief complaint key terms varied markedly from 0% to 61% and resulted in an empirically-driven resorting of the priority tiers. After excluding clearly ineligible participants, 49% of charts reviewed in the first study and 60% of charts reviewed in the second study were identified as a possible or probable mTBI. This indicates an improvement in overall efficiency (12%; χ2(1)=114.7, p<.001) compared to the original system. Conclusion: The revised tiered priority chart review system was more efficient at identifying patients with mTBI for the purposes of mTBI study recruitment. Keywords: chart review; electronic health record, electronic medical record; mTBI; mild traumatic brain injury; algorithm; key term; concussion; chart review system; tiered priority screening system; recruitment; mTBI; TBI; emergency department recruitment.; chief complaint; reason for visit.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

University of British Columbia Research Ethics (Ethics Committee) of University of British Columbia gave ethical approval for this work

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors