Theresa Louise Bender Pape1, Bridget Smith2, Judith Babcock-Parziale3, Charlesnika T Evans4, Amy A Herrold5, Kelly Phipps Maieritsch6, Walter M High7. 1. Department of Veterans Affairs (VA), Research Service, Edward Hines Jr. VA Hospital, Hines, IL; VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: Theresa.Pape@va.gov. 2. VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. 3. Southern Arizona VA Health Care System, Tucson, AZ. 4. VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL; Department of Preventive Medicine and Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 5. Department of Veterans Affairs (VA), Research Service, Edward Hines Jr. VA Hospital, Hines, IL; VA, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. 6. Department of Veterans Affairs, Mental Health Service, Edward Hines Jr. VA Hospital, Hines, IL. 7. Lexington VA Medical Center, Somerset, KY; Departments of Physical Medicine and Rehabilitation, Neurosurgery, and Psychology, University of Kentucky College of Medicine, Lexington, KY.
Abstract
OBJECTIVE: To comprehensively estimate the diagnostic accuracy and reliability of the Department of Veterans Affairs (VA) Traumatic Brain Injury (TBI) Clinical Reminder Screen (TCRS). DESIGN: Cross-sectional, prospective, observational study using the Standards for Reporting of Diagnostic Accuracy criteria. SETTING: Three VA Polytrauma Network Sites. PARTICIPANTS: Operation Iraqi Freedom, Operation Enduring Freedom veterans (N=433). MAIN OUTCOME MEASURES: TCRS, Comprehensive TBI Evaluation, Structured TBI Diagnostic Interview, Symptom Attribution and Classification Algorithm, and Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale. RESULTS: Forty-five percent of veterans screened positive on the TCRS for TBI. For detecting occurrence of historical TBI, the TCRS had a sensitivity of .56 to .74, a specificity of .63 to .93, a positive predictive value (PPV) of 25% to 45%, a negative predictive value (NPV) of 91% to 94%, and a diagnostic odds ratio (DOR) of 4 to 13. For accuracy of attributing active symptoms to the TBI, the TCRS had a sensitivity of .64 to .87, a specificity of .59 to .89, a PPV of 26% to 32%, an NPV of 92% to 95%, and a DOR of 6 to 9. The sensitivity was higher for veterans with PTSD (.80-.86) relative to veterans without PTSD (.57-.82). The specificity, however, was higher among veterans without PTSD (.75-.81) relative to veterans with PTSD (.36-.49). All indices of diagnostic accuracy changed when participants with questionably valid (QV) test profiles were eliminated from analyses. CONCLUSIONS: The utility of the TCRS to screen for mild TBI (mTBI) depends on the stringency of the diagnostic reference standard to which it is being compared, the presence/absence of PTSD, and QV test profiles. Further development, validation, and use of reproducible diagnostic algorithms for symptom attribution after possible mTBI would improve diagnostic accuracy. Published by Elsevier Inc.
OBJECTIVE: To comprehensively estimate the diagnostic accuracy and reliability of the Department of Veterans Affairs (VA) Traumatic Brain Injury (TBI) Clinical Reminder Screen (TCRS). DESIGN: Cross-sectional, prospective, observational study using the Standards for Reporting of Diagnostic Accuracy criteria. SETTING: Three VA Polytrauma Network Sites. PARTICIPANTS: Operation Iraqi Freedom, Operation Enduring Freedom veterans (N=433). MAIN OUTCOME MEASURES: TCRS, Comprehensive TBI Evaluation, Structured TBI Diagnostic Interview, Symptom Attribution and Classification Algorithm, and Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale. RESULTS: Forty-five percent of veterans screened positive on the TCRS for TBI. For detecting occurrence of historical TBI, the TCRS had a sensitivity of .56 to .74, a specificity of .63 to .93, a positive predictive value (PPV) of 25% to 45%, a negative predictive value (NPV) of 91% to 94%, and a diagnostic odds ratio (DOR) of 4 to 13. For accuracy of attributing active symptoms to the TBI, the TCRS had a sensitivity of .64 to .87, a specificity of .59 to .89, a PPV of 26% to 32%, an NPV of 92% to 95%, and a DOR of 6 to 9. The sensitivity was higher for veterans with PTSD (.80-.86) relative to veterans without PTSD (.57-.82). The specificity, however, was higher among veterans without PTSD (.75-.81) relative to veterans with PTSD (.36-.49). All indices of diagnostic accuracy changed when participants with questionably valid (QV) test profiles were eliminated from analyses. CONCLUSIONS: The utility of the TCRS to screen for mild TBI (mTBI) depends on the stringency of the diagnostic reference standard to which it is being compared, the presence/absence of PTSD, and QV test profiles. Further development, validation, and use of reproducible diagnostic algorithms for symptom attribution after possible mTBI would improve diagnostic accuracy. Published by Elsevier Inc.
Entities:
Keywords:
Brain injuries, traumatic; Mass screening; Rehabilitation; Sensitivity and specificity; Veterans
Authors: Erin D Ozturk; Catherine Chanfreau-Coffinier; McKenna S Sakamoto; Lisa Delano-Wood; Victoria C Merritt Journal: J Psychiatr Res Date: 2021-12-14 Impact factor: 5.250