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Updated: Jun 3, 2026
System for Focal, Closed-System Central Nervous System Injury
Published on: November 29, 2024
Postdeployment traumatic brain injury screening questions: Sensitivity, specificity, and predictive values in
Heidi P Terrio1, Lonnie A Nelson, Lisa M Betthauser
1Department of Deployment Health, Evans Army Community Hospital, Defense and Veterans Brain Injury Center, Fort Carson, CO, USA. heidi.terrio@amedd.army.mil
Objective:
To evaluate the sensitivity, specificity, and predictive values of Post-Deployment Health Assessment traumatic brain injury (TBI) screening questions employed by the Department of Defense (DOD).
Participants:
Complete data was obtained from 3,072 soldiers upon return from a 15-month deployment to Iraq.
Method:
Comparisons were made between responses to the DOD four-item screener and a brief structured clinical interview for likely deployment-related TBI history. The interview process was facilitated using responses to the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT).
Results:
The sensitivity and specificity of the DOD screening tool (positive response to all four items) in comparison to the clinician-confirmed diagnosis was 60% and 96%, respectively. The sensitivity increased to 80%, with a slight decrease in specificity to 93%, for positive TBI screening when affirmative responses to questions 1 and 2 only were included.
Conclusions:
Affirmative responses to questions 1 and 2 of the DOD TBI screening tool demonstrated higher sensitivity for clinician-diagnosed deployment-related TBI. These two items perform better than positive responses to all four questions; the criteria presently being used for documentation and referral of a deployment-related TBI. These findings support further exploration of TBI screening and assessment procedures.
