Article

Challenges Associated with Post-Deployment Screening for Mild Traumatic Brain Injury in Military Personnel

University of British Columbia & British Columbia Mental Health & Addiction Services, Vancouver, BC, Canada.
The Clinical Neuropsychologist (Impact Factor: 1.58). 11/2009; 23(8):1299-314. DOI: 10.1080/13854040903153902
Source: PubMed

ABSTRACT There is ongoing debate regarding the epidemiology of mild traumatic brain injury (MTBI) in military personnel. Accurate and timely estimates of the incidence of brain injury and the prevalence of long-term problems associated with brain injuries among active duty service members and veterans are essential for (a) operational planning, and (b) to allocate sufficient resources for rehabilitation and ongoing services and supports. The purpose of this article is to discuss challenges associated with post-deployment screening for MTBI. Multiple screening methods have been used in military, Veterans Affairs, and independent studies, which complicate cross-study comparisons of the resulting epidemiological data. We believe that post-deployment screening is important and necessary--but no screening methodology will be flawless, and false positives and false negatives are inevitable. Additional research is necessary to refine the sequential screening methodology, with the goal of minimizing false negatives during initial post-deployment screening and minimizing false positives during follow-up evaluations.

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    • "If somatic, emotional, or cognitive symptoms persist beyond 3 months, they are often not related to the neurological effects of the mTBI or concussion (Hou et al., 2012; Ponsford et al., 2012). Rather, other factors have been implicated, such as baseline characteristics (e.g., prior psychopathology; de Leon et al., 2009), headache and pain (Iverson & McCracken, 1997), vestibular dysfunction (Iverson et al., 2009), unrealistic appraisal of pre-injury status (Gunstad & Suhr, 2001; Iverson et al., 2010), inaccurate self-report (Barsky, 2002), inaccurate illness perception (Whittaker, Kemp, & House, 2007), and the non-specific nature of mTBI and concussion symptoms, leading to misattribution of symptoms (Lees-Haley, Fox, & Courtney, 2001). In fact, it has even been found that mTBI does not predict PCS (Meares et al., 2011). "
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    • "Postdeployment, the Brief Traumatic Brain Injury Survey (BTBIS)47 included in the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT) or the Post-Deployment Health Assessment (PDHA) is administered to the soldiers.48 These screening measures are designed to be overly inclusive to reduce the risk of overlooking individuals with TBI;44 any positive screen would need to be followed by a clinical interview and examination to either confirm or negate the diagnosis of mTBI. Evidence of structural brain damage is not part of the mTBI diagnostic criteria.13 "
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