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Detecting Behavioral Deficits in Rats After Traumatic Brain Injury
Published on: January 30, 2018
Diagnostic Accuracy of the Veteran Affairs' Traumatic Brain Injury Screen
Theresa Louise Bender Pape1, Bridget Smith2, Judith Babcock-Parziale3
1Department 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.
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.
