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: 1.72). 11/2009; 23(8):1299-314. DOI: 10.1080/13854040903153902
Source: PubMed


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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    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
    • "As noted above, retrospective identification of TBI (civilian and combat) can be challenging (see Brenner, Vanderploeg, & Terrio, 2009; Corrigan & Bogner, 2007a; Schwab et al., 2007; Terrio et al., 2009). Some issues can be addressed if assessments are completed using a structured clinical interview (Iverson, Langlois, McCrea & Kelly, 2009). Currently, this is the gold standard for retrospective TBI assessment (Corrigan & Bogner, 2007a). "
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    ABSTRACT: To evaluate the sensitivity, specificity, and predictive values of Post-Deployment Health Assessment traumatic brain injury (TBI) screening questions employed by the Department of Defense (DOD). Participants: Complete data was obtained from 3,072 soldiers upon return from a 15-month deployment to Iraq. Comparisons were made between responses to the DOD four-item screener and a brief structured clinical interview for likely deployment-related TBI history. The interview process was facilitated using responses to the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT). The sensitivity and specificity of the DOD screening tool (positive response to all four items) in comparison to the clinician-confirmed diagnosis was 60% and 96%, respectively. The sensitivity increased to 80%, with a slight decrease in specificity to 93%, for positive TBI screening when affirmative responses to questions 1 and 2 only were included. Affirmative responses to questions 1 and 2 of the DOD TBI screening tool demonstrated higher sensitivity for clinician-diagnosed deployment-related TBI. These two items perform better than positive responses to all four questions; the criteria presently being used for documentation and referral of a deployment-related TBI. These findings support further exploration of TBI screening and assessment procedures.
    Rehabilitation Psychology 02/2011; 56(1):26-31. DOI:10.1037/a0022685 · 1.91 Impact Factor
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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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    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 · 4.38 Impact Factor
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