Challenges with Tracking Post Concussive Symptoms Using the Neurobehavioral Symptom Inventory in Active Duty Service...

Area of Science:

• Neurology
• Military Medicine
• Public Health

Background:

• Guidance for monitoring post-concussive symptoms after mild traumatic brain injury (mTBI) was issued in 2007.
• Clinical practice guidelines since 2009 emphasized routine symptom monitoring, with the Neurobehavioral Symptom Inventory (NSI) specifically recommended in 2015.
• The study focuses on the Military Health System (MHS) electronic medical record (EMR) for Service Members diagnosed with mTBI post-9/11.

Purpose of the Study:

• To determine the frequency of NSI administration within one year of mTBI diagnosis.
• To describe NSI documentation in the MHS EMR for Active-Duty Service Members.
• To identify trends in NSI administration over time.

Main Methods:

• Data extracted from the MHS Data Repository for Service Members with an index mTBI between FY2002-2021.
• Exclusion of Service Members with severe TBI or catastrophic injuries.
• Matching mTBI data with NSI completion records from the DoD TBI portal to assess administration within one year of the index mTBI.

Main Results:

• Only 2.2% (3,351) of Service Members with an index mTBI had an NSI documented in the EMR.
• Within one year of mTBI diagnosis, only 0.78% (1,182) of NSIs were recorded.
• The prevalence of documented NSIs increased over time, peaking in 2019.

Conclusions:

• Findings indicate infrequent administration and documentation of the NSI following mTBI.
• System- and individual-level barriers likely contribute to low NSI utilization.
• Further research is needed to identify barriers and facilitators to improve NSI implementation and measurement-based care for Service Members.