Screening for mild traumatic brain injury in OEF-OIF deployed US military: An empirical assessment of VHA's experience

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

doi:10.3109/02699052.2012.729284

Cited by 57 publications

(36 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…False positive screens for TBI may occur if the Veteran has other conditions, including PTSD or other conditions that have concussion-like symptoms, such as hearing loss and vestibular changes [21]. The proportion of screened TBI Veterans who completed a secondary TBI assessment and subsequently received a physician diagnosis of TBI was 53 percent, which is consistent with the proportion of approximately 60 percent found in other studies [22][23]. The reported symptom prevalence was similar in both the screened TBI and the confirmed TBI groups (70% vs 72%).…”

Section: Discussionsupporting

confidence: 80%

Identification of pseudobulbar affect symptoms in Veterans with possible traumatic brain injury

Fonda

Hunt²,

McGlinchey

et al. 2015

J Rehabil Res Dev

View full text Add to dashboard Cite

Abstract-Pseudobulbar affect (PBA), a neurological syndrome characterized primarily by involuntary episodes of laughing and crying, can develop secondary to neurological conditions including traumatic brain injury (TBI). Veterans of the wars in Afghanistan and Iraq have an unprecedented risk for TBI, primarily from blast-related munitions. In this crosssectional study with linkage to Department of Veterans Affairs (VA) clinical data, Veterans screening positive for TBI on the VA TBI screen (N = 4,282) were mailed packets containing two PBA symptom assessments: a single PBA symptom screen question and the Center for Neurologic Study-Lability Scale (CNS-LS) questionnaire. Seventy percent (n = 513) of the 728 Veteran respondents screened positive for PBA symptoms with a CNS-LS score of 13 or greater. There was strong concordance between PBA symptom prevalence measured with the single screening question and CNS-LS, with high sensitivity (0.87) and positive predictive value (0.93) and moderate specificity (0.79). Posttraumatic stress disorder (54% vs 32%), major depression (35% vs 22%), and anxiety disorder (20% vs 13%) were more common for Veterans with PBA symptoms than for those without. PBA symptoms were common in this Veteran cohort, were detected using simple screening tools, and often co-occurred with other psychiatric disorders common in Veterans.

show abstract

Section: Discussionsupporting

confidence: 80%

Identification of pseudobulbar affect symptoms in Veterans with possible traumatic brain injury

Fonda

Hunt²,

McGlinchey

et al. 2015

J Rehabil Res Dev

View full text Add to dashboard Cite

show abstract

“…Thus, the TBI screen, in part, fulfills the intended goal of population-based screening in detecting postdeployment problems if they are present and has been shown to lead to increased VA care utilization, although we do not know whether this care was appropriate or indicated [37]. At the same time, the TBI screen may be too nonspecific and have unintended iatrogenic consequences as argued by Hoge et al, who raise the concern that the current TBI screening process may result in the misattribution of cognitive and other postconcussive symptoms to mTBI, when in fact, these problems are more likely due to conditions and diagnoses other than mTBI [38][39].…”

Section: Memory and Attentionmentioning

confidence: 99%

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans

Seal¹,

Bertenthal²,

Samuelson³

et al. 2016

J Rehabil Res Dev

View full text Add to dashboard Cite

Abstract-The Department of Veterans Affairs traumatic brain injury (TBI) screening program is intended to detect and expedite treatment for TBI and postconcussive symptoms. Between April 14, 2007, and May 31, 2012, of 66,089 Iraq and Afghanistan Veterans who screened positive on first-level TBI screening and later completed comprehensive TBI evaluation that includes the Neurobehavioral Symptoms Inventory, 72% reported moderate to very severe cognitive impairment (problems with attention, concentration, memory, etc.) that interfered with daily activities. This included 42% who were found not to have sustained combat-related mild TBI (mTBI). In contrast, 70.0% received a posttraumatic stress disorder (PTSD) diagnosis and 45.8% received a depression diagnosis. Compared with Veterans without mTBI, PTSD, or depression diagnoses, the lowest risk for self-reported cognitive impairment was in Veterans with confirmed mTBI only; a greater risk was found in those with PTSD diagnoses, with the greatest risk in Veterans with PTSD, depression, and confirmed mTBI, suggesting only a weakly additive effect of mTBI. These findings suggest that Veterans with multiple mental health comorbidities, not just those with TBI, report moderate to very severe cognitive impairment. Mental health treatment for conditions such as PTSD and depression (with or without TBI) may result in improvements in cognitive functioning and/or include assessment and support for Veterans experiencing cognitive problems.

show abstract

“…Patients who report a prior TBI diagnosis upon screening are offered a referral for follow-up treatment. Patients without a prior TBI diagnosis are asked four sets of TBI screening questions regarding (1) events that increase TBI risk, (2) immediate symptoms following the event, (3) new or worsening symptoms postevent, and (4) current symptoms. Patients endorsing one or more questions in each of the four sections screen positive and are offered a referral for a VA comprehensive TBI evaluation (CTBIE) [11,19,[21][22].…”

Section: Traumatic Brain Injury Screening and Evaluationmentioning

confidence: 99%

“…Recent estimates indicate self-reported or clinician-confirmed traumatic brain injury (TBI) ranging from 6.8 to 22.8 percent of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) servicemembers and Veterans [1][2][3][4][5][6]. Blast (e.g., from bombs or improvised explosive devices [IEDs]) is the most prevalent mechanism of mTBI for OIF/OEF servicemembers [7][8][9], and vehicular accidents and falls [4,6] are other common etiologies of TBI among OIF/OEF servicemembers.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2014

Self Cite

View full text Add to dashboard Cite

Abstract-The concordance of Department of Veterans Affairs (VA) clinician judgment of mild traumatic brain injury (mTBI) history with American Congress of Rehabilitation Medicine (ACRM)-based criteria was examined for Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans. In order to understand inconsistencies in agreement, we also examined the associations between evaluation outcomes and conceptually relevant patient characteristics, deployment-related events, current self-reported health symptoms, and suspected psychiatric conditions. The Veteran sample comprised 14,026 OIF/OEF VA patients with deployment-related mTBI history (n = 9,858) or no history of mTBI (n = 4,168) as defined by ACRM-based criteria. In the majority of cases (76.0%), clinician judgment was in agreement with the ACRM-based criteria. The most common inconsistency was between clinician judgment (no) and ACRM-based criteria (yes) for 21.3% of the patients. Injury etiology, current self-reported health symptoms, and suspected psychiatric conditions were additional factors associated with clinician diagnosis and ACRM-based criteria disagreement. Adherence to established diagnostic guidelines is essential for accurate determination of mTBI history and for understanding the extent to which mTBI symptoms resolve or persist over time in OIF/OEF Veterans.

show abstract

Screening for mild traumatic brain injury in OEF-OIF deployed US military: An empirical assessment of VHA's experience

Cited by 57 publications

References 33 publications

Identification of pseudobulbar affect symptoms in Veterans with possible traumatic brain injury

Identification of pseudobulbar affect symptoms in Veterans with possible traumatic brain injury

Association between mild traumatic brain injury and mental health problems and self-reported cognitive dysfunction in Iraq and Afghanistan Veterans

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

Contact Info

Product

Resources

About