Challenges Associated with Post-Deployment Screening for Mild Traumatic Brain Injury in Military Personnel
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.
- SourceAvailable from: Jerry J Sweet
[Show abstract] [Hide abstract]
- "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). "
ABSTRACT: Traumatic brain injury (TBI) occurs at a high incidence, involving millions of individuals in the U.S. alone. Related to this, there are large numbers of litigants and claimants who are referred annually for forensic evaluation. In formulating opinions regarding claimed injuries, the present review advises experts to rely on two sets of information: TBI outcome and neuropsychological dose-response studies of non-litigants and non-claimants, and response bias literature that has demonstrated the relatively high risk of invalid responding among examinees referred within a secondary gain context, which in turn has resulted in the development of specific assessment methods. Regarding prospective methods for detecting possible response bias, both symptom validity tests, for measuring over-reporting of symptoms on inventories and questionnaires, and performance validity tests, for measuring insufficient effort on ability tests, are considered essential. Copyright © 2013 John Wiley & Sons, Ltd.Behavioral Sciences & the Law 11/2013; 31(6). DOI:10.1002/bsl.2088 · 0.96 Impact Factor
[Show abstract] [Hide abstract]
- "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 "
ABSTRACT: The etiology, imaging, and behavioral assessment of mild traumatic brain injury (mTBI) are daunting fields, given the lack of a cohesive neurobiological explanation for the observed cognitive deficits seen following mTBI. Although subjective patient self-report is the leading method of diagnosing mTBI, current scientific evidence suggests that quantitative measures of predictive timing, such as visual tracking, could be a useful adjunct to guide the assessment of attention and to screen for advanced brain imaging. Magnetic resonance diffusion tensor imaging (DTI) has demonstrated that mTBI is associated with widespread microstructural changes that include those in the frontal white matter tracts. Deficits observed during predictive visual tracking correlate with DTI findings that show lesions localized in neural pathways subserving the cognitive functions often disrupted in mTBI. Unifying the anatomical and behavioral approaches, the emerging evidence supports an explanation for mTBI that the observed cognitive impairments are a result of predictive timing deficits caused by shearing injuries in the frontal white matter tracts.Annals of the New York Academy of Sciences 10/2010; 1208(1):58-66. DOI:10.1111/j.1749-6632.2010.05695.x · 4.31 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND:Although mortality rates for some cardiovascular procedures seem to have declined, it is unclear whether other high-risk procedures are becoming safer over time.STUDY DESIGN:We examined national trends between 1994 and 1999 in operative mortality for 14 high-risk cardiovascular and cancer procedures in the national population of Medicare beneficiaries over age 65. Secular trends were examined using logistic regression adjusting for age, gender, race, socioeconomic status, admission acuity, comorbidities, and hospital volume.RESULTS:Observed mortality rates varied widely across the 14 procedures, from 2% (carotid endarterectomy) to 16% (esophagectomy). Over the 6-year study period, average patient age increased for all procedures, and patients were more likely to undergo operation at high-volume hospitals for some procedures (pancreatic resection, esophagectomy, cystectomy, and pneumonectomy). After accounting for these changes, operative mortality declined significantly for three cardiovascular procedures, as evidenced by adjusted odds ratios (OR) for the 6-year effect on operative mortality (coronary artery bypass graft OR = 0.85, 95% confidence interval [CI] 0.81 to 0.88; carotid endarterectomy OR = 0.86, 95% CI 0.80 to 0.93; mitral valve replacement OR = 0.89, 95% CI 0.81 to 0.97). In contrast, operative mortality did not decline for any of the cancer procedures. In fact, adjusted mortality increased for colectomy for colon cancer (OR = 1.13, 95% CI 1.07 to 1.19).CONCLUSIONS:Although risks of some cardiovascular procedures are declining over time, there is no evidence that other types of high-risk surgery are becoming safer. These findings suggest the need for systematic efforts to monitor and improve surgical performance.Journal of the American College of Surgeons 08/2002; 195(2):219-227. DOI:10.1016/S1072-7515(02)01228-0 · 4.45 Impact Factor