Concordance of clinician judgment of mild traumatic brain injury history with a diagnostic standard

Pogoda, Terri K.; Iverson, Katherine M.; Meterko, Mark; Baker, Errol; Stolzmann, Kelly; Krengel, Maxine; Charns, Martin P.; Amara, Jomana; Kimerling, Rachel; Lew, Henry L.

doi:10.1682/jrrd.2013.05.0115

Cited by 16 publications

(4 citation statements)

References 35 publications

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“…Powell and colleagues [ 12 ] found that over half of the 197 patients identified as having a mTBI by study personnel were not documented with that diagnosis by medical personnel in the ED. Within the Veteran population, Pogoda and colleagues [ 13 ] showed that clinical judgment differed from ACRM-based criteria for mTBI history in 24% of the cases seen for a comprehensive TBI evaluation, with the majority of these disagreements indicating that clinician judgment on mTBI diagnosis was inconsistent with ACRM-based criteria (Clinician N/ACRM Y). This outcome of Clinician N/ACRM Y reportedly occurred more often when veterans reported higher affective symptoms accompanied by lower reported cognitive and physical symptoms.…”

Section: Acute Identification and Evaluation Of Mild Traumatic Bramentioning

confidence: 99%

Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology

Prince¹,

2017

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Awareness of mild traumatic brain injury (mTBI) and persisting post-concussive syndrome (PCS) has increased substantially in the past few decades, with a corresponding increase in research on diagnosis, management, and treatment of patients with mTBI. The purpose of this article is to provide a narrative review of the current literature on behavioral assessment and management of patients presenting with mTBI/PCS, and to detail the potential role of neuropsychologists and rehabilitation psychologists in interdisciplinary care for this population during the acute, subacute, and chronic phases of recovery.

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Section: Acute Identification and Evaluation Of Mild Traumatic Bramentioning

confidence: 99%

Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology

Prince¹,

2017

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“…This instrument uses modified versions of items from the Comprehensive TBI Evaluation (CTBIE) (18), which is currently used by the VA to assess veterans' history of TBI during military service. Previous research has shown that in the majority of cases (76%), clinical judgment based on CTBIE template aligns with established diagnostic criteria (19). Participants who reported a history of one or more head injuries that resulted in a loss of consciousness, period of disorientation or confusion, memory loss, or skull penetration were categorized as positive for probable TBI history.…”

Section: Methodsmentioning

confidence: 99%

Military and Nonmilitary TBI Associations with Hearing Loss and Self-Reported Hearing Difficulty among Active-Duty Service Members and Veterans

Hughes,

Thapa,

Theodoroff

et al. 2024

Otol Neurotol

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Objective Identify associations between self-reported history of military and nonmilitary traumatic brain injury (TBI) on hearing loss and hearing difficulty from the Noise Outcomes in Servicemembers Epidemiology (NOISE) study. Study Design Cross-sectional. Setting Multi-institutional tertiary referral centers. Patients Four hundred seventy-three Active-Duty Service members (ADSM) and 502 veterans. Exposure Self-reported history of no TBI, military TBI only, nonmilitary TBI only, both military and nonmilitary TBI. Main Outcome Measures Pure-tone hearing thresholds, Speech Recognition In Noise Test (SPRINT), Hearing Handicap Inventory for Adults (HHIA), and Speech, Spatial and Qualities of Hearing Scale (SSQ)-12. Results 25% (120/473) of ADSM and 41% (204/502) of veterans self-reported a TBI. Military TBI was associated with poorer hearing thresholds in all frequency ranges in veterans (adjusted mean difference, 1.8 dB; 95% confidence interval [CI], 0.5–3.0; 3.3, 0.8–5.8; 5.1; 1.7–8.5, respectively), and in the high frequency range in ADSM (mean difference, 3.2 dB; 95% CI, 0.1–6.3). Veterans with military TBI only and nonmilitary TBI only had lower odds of correctly identifying speech in noise than veterans with no TBI (odds ratio [OR], 0.78; 95% CI, 0.72–0.83; 0.90; 0.84–0.98). ADSM with a military TBI (OR, 5.7; 95% CI, 2.6–12.5) and veterans with any TBI history (OR, 2.5; 95% CI, 1.5–4.3; OR, 2.2; 95% CI, 1.3–3.8; OR, 4.5; 95% CI, 2.1–9.8) were more likely to report hearing difficulty on HHIA. SSQ-12 results corroborated HHIA findings. Conclusions Military TBI was associated with poorer hearing thresholds in veterans and ADSM, and poorer SPRINT scores in veterans. Military TBI was associated with poorer self-perceived hearing ability in ADSM. All types of TBI were associated with poorer self-perceived hearing ability in veterans, although the strength of this association was greatest for military TBI.

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“…5 These data suggest that many patients with TBI are being discharged without a diagnosis. 5,6 Documented diagnosis of TBI is critical to ensure that patients recognize the injury they have incurred, are aware of the potential for long-lasting effects, and receive appropriate follow-up care to minimize the impact on their lives.…”

Section: Introductionmentioning

confidence: 99%

Discordance between Documented Criteria and Documented Diagnosis of Traumatic Brain Injury in the Emergency Department

Cota

Moses

Jikaria

et al. 2019

Journal of Neurotrauma

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Accurate diagnosis of traumatic brain injury (TBI) is critical to ensure that patients receive appropriate follow-up care, avoid risk of subsequent injury, and are aware of possible long-term consequences. However, diagnosis of TBI, particularly in the emergency department (ED), can be difficult because the symptoms of TBI are vague and nonspecific, and patients with suspected TBI may present with additional injuries that require immediate medical attention. We performed a retrospective chart review to evaluate accuracy of TBI diagnosis in the ED. Records of 1641 patients presenting to the ED with suspected TBI and a head computed tomography (CT) were reviewed. We found only 47% of patients meeting the American Congress of Rehabilitation Medicine criteria for TBI received a documented ED diagnosis of TBI in medical records. After controlling for demographic and clinical factors, patients presenting at a level I trauma center, with cause of injury other than fall, without CT findings of TBI, and without loss of consciousness were more likely to lack documented diagnosis despite meeting diagnostic criteria for TBI. A greater proportion of patients without documented ED diagnosis of TBI were discharged home compared to those with a documented diagnosis of TBI (58% vs. 40%; p < 0.001). Together, these data suggest that many patients who have sustained a TBI are discharged home from the ED without a documented diagnosis of TBI, and that improved awareness and implementation of diagnostic criteria for TBI is important in the ED and for in-and outpatient providers.

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Concordance of clinician judgment of mild traumatic brain injury history with a diagnostic standard

Cited by 16 publications

References 35 publications

Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology

Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology

Military and Nonmilitary TBI Associations with Hearing Loss and Self-Reported Hearing Difficulty among Active-Duty Service Members and Veterans

Discordance between Documented Criteria and Documented Diagnosis of Traumatic Brain Injury in the Emergency Department

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