New Zealand’s ACC seeks development of brain injury screening tool

New Zealand’s Accident Compensation Corporation (ACC) is seeking a provider to develop a comprehensive solution for their Brain Injury Screening Tool (BIST), which is presently in prototype.

The intent is for a data-sharing platform to host the BIST, making it available to health practitioners.

The BIST was designed as a rapid questionnaire to be completed by individuals after an injury to help direct care decisions and track progress. Its goal is to serve as a conversational guide for clinical assessments using current worldwide best practice recommendations.

The current prototype, developed in collaboration with the Auckland University of Technology (AUT) Traumatic Brain Injury Network,  is in pdf form and licensed under a Creative Commons Attribution-Non-commercial-No-Derivatives 4.0 International License.

The AUT Traumatic Brain Injury Network seeks to bring together people, resources, and research to learn how to prevent and improve recovery from traumatic brain injury.

A traumatic brain injury (TBI) is a terrible occurrence that has the potential to affect individuals regardless of their circumstances. The annual incidence of traumatic brain injuries (TBIs) in New Zealand is estimated to be approximately 35,000 individuals.

Out of these cases, a substantial majority, around 95% or 33,250 instances, are classified as mild traumatic brain injuries (mTBIs). Nevertheless, it is worth noting that out of the total cases, only 22,000 persons file claims with ACC, suggesting that a significant portion of the population refrains from seeking medical treatment for their injuries.

The primary causes of traumatic brain injuries (TBIs) in New Zealand encompass incidents such as falls, leisure activities or sports (constituting around 20% to 30% of the total cases), operation of machinery, vehicular collisions, and acts of physical violence.

Many people recover well in the days to weeks following mTBI, but more than 40% can have long-term symptoms that interfere with everyday life. A history of (prior) TBI, a pre-existing mental health problem, delayed medical care (including patient delays in seeking treatment), older age and greater severity of acute symptoms have all been identified as risk factors for poor recovery outcomes. Evidence shows that early detection and treatment promote long-term recovery.

The questionnaire asked the patient to rate, on a scale from 0 to 10, the presence and severity of 16 symptoms. The severity of an injury can then be measured on a scale from 0 to 100. Scores above 50 indicate significant symptom severity. The BIST has demonstrated high reliability and validity in studies and has been designed to make completion straightforward. When completed, the tool proposes the optimum healthcare course for a patient, but it is merely a guide. The clinician makes the final choice.

The financial impacts of traumatic brain injuries (TBIs) in New Zealand are considerable and have exhibited a consistent upward trend.

The economic cost of active claims in the 22/23 FY, that is, claims that generated a payment during the applicable fiscal year, amounted to over $567 million.

This represents a doubling over the previous decade. The observed rise in expenses not only signifies the escalating prevalence of traumatic brain injury (TBI) instances but also emphasises the increasing economic strain on the healthcare system and the broader economy.

The increase in expenditures over a decade underscores the need for more robust preventive measures, advancements in treatment modalities, and the adoption of streamlined approaches to the management of traumatic brain injuries (TBIs) to alleviate the mounting personal and financial burden.

The ACC Concussion Clinical Expert Group led the development of this questionnaire, which has undergone reviews and updates based on research evidence and clinical implementation learnings.

Overall, the BIST represents a significant advancement in managing and assessing brain injuries, aligning with best practices and providing a practical, evidence-based tool for healthcare professionals.

Following the proposal submission and assessment procedure, the contracts for the selected service providers are expected to be finalised and in place by February 2024.