Postdeployment traumatic brain injury screening questions: Sensitivity, specificity, and predictive values in...

Area of Science:

• Military medicine
• Neurology
• Public health

Background:

• Traumatic brain injury (TBI) is a significant concern for military personnel following deployment.
• The Department of Defense (DOD) utilizes a Post-Deployment Health Assessment to screen for TBI.
• Accurate TBI screening is crucial for timely diagnosis and management.

Purpose of the Study:

• To evaluate the diagnostic accuracy of the DOD's TBI screening questions.
• To compare the sensitivity and specificity of different screening criteria.
• To identify optimal screening methods for deployment-related TBI.

Main Methods:

• A study involving 3,072 soldiers returning from a 15-month deployment to Iraq.
• Comparison of responses from the DOD's four-item TBI screener against a structured clinical interview.
• Utilized the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT) to guide the interview process.

Main Results:

• The DOD TBI screener (all four items) had 60% sensitivity and 96% specificity for clinician-diagnosed TBI.
• Using only the first two screening questions increased sensitivity to 80% while maintaining 93% specificity.
• This suggests a modification to the screening criteria may improve detection rates.

Conclusions:

• Affirmative responses to the first two questions of the DOD TBI screening tool show superior sensitivity for identifying clinician-diagnosed, deployment-related TBI.
• These two items outperform the current four-item criteria for TBI documentation and referral.
• Further research into refining TBI screening and assessment procedures is recommended.