Diagnostic Accuracy of the Veteran Affairs’ Traumatic Brain Injury Screen

Publication date: Available online 31 January 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Theresa Louise-Bender Pape, Bridget Smith, Judith Babcock-Parziale, Charlesnika T. Evans, Amy A. Herrold, Kelly Phipps Maieritsch, Walter M. High
ObjectiveTo comprehensively estimate the diagnostic accuracy and reliability of the Department of Veterans Affairs (VA) TBI Clinical Reminder Screen (TCRS).DesignCross-sectional, prospective, observational study using the Standards for Reporting of Diagnostic Accuracy (STARD) criteria.SettingThree VA Polytrauma Network Sites.Participants433 Operation Iraqi Freedom, Operation Enduring Freedom (OEF/OIF) Veterans.Main Outcome MeasuresTCRS, Comprehensive TBI Evaluation (CTBIE), Structured TBI Diagnostic Interview (STDI), Symptom Attribution and Classification Algorithm (SACA), Clinician-Administered PTSD Scale (CAPS).Results45% of Veterans screened positive on the TCRS for TBI. For detecting occurrence of historical TBI, the TCRS had 0.56-0.74 sensitivity (Se), 0.63-0.93 specificity (Sp), 25-45% Positive Predictive Value (PPV), 91-94% Negative Predictive Value (NPV), and 4-13 diagnostic odds ratio (DOR). For accuracy of attributing active symptoms to the TBI, the TCRS had 0.64-0.87 Se, 0.59-0.89 Sp, 26-32% PPV, 92-95% NPV, and 6-9 DOR. The Se was higher for Veterans with PTSD (0.80-0.86) relative to Veterans without PTSD (0.56-0.82). The Sp, however, was higher among Veterans without PTSD (0.75-0.90) relative to Veterans with PTSD (0.36-0.73). All indices of diagnostic accuracy changed when participants with questionably valid (QV) test profiles were eliminated from analyses.ConclusionsThe utility of the TCRS to screen for 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 following possible mTBI would improve diagnostic accuracy.



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