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: Deirdre Macmanus[Show abstract] [Hide abstract]
ABSTRACT: We assessed the strength of the association of several mental health problems, childhood difficulties, and combat role with anger, as well as the contribution of these factors to explain anger assessed by population attributable fraction (PAF). A total of 9885 UK service personnel, some of them deployed to Iraq and Afghanistan, participated in the study. There was a strong or intermediate association between cases and subthreshold cases of symptoms of posttraumatic stress disorder, psychological distress, multiple physical symptoms and alcohol misuse, having a combat role, childhood adversity, and childhood antisocial behavior with anger. The PAF for any mental health problem and combat role and childhood difficulties was 0.64 (95% confidence interval [CI], 0.56-0.70) and increased to 0.77 (95% CI, 0.69-0.83) if subthreshold cases were included. Anger is a frequent component of mental disorders; health care professionals need to be aware of the interference of anger in the management of mental illness and that anger infrequently presents as an isolated phenomenon.
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ABSTRACT: The concordance of Department of Veterans Affairs (VA) clinician judgment of mild traumatic brain injury (mTBI) history with American Congress of Rehabilitation Medicine (ACRM)-based criteria was examined for Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans. In order to understand inconsistencies in agreement, we also examined the associations between evaluation outcomes and conceptually relevant patient characteristics, deployment-related events, current self-reported health symptoms, and suspected psychiatric conditions. The Veteran sample comprised 14,026 OIF/OEF VA patients with deployment-related mTBI history (n = 9,858) or no history of mTBI (n = 4,168) as defined by ACRM-based criteria. In the majority of cases (76.0%), clinician judgment was in agreement with the ACRM-based criteria. The most common inconsistency was between clinician judgment (no) and ACRM-based criteria (yes) for 21.3% of the patients. Injury etiology, current self-reported health symptoms, and suspected psychiatric conditions were additional factors associated with clinician diagnosis and ACRM-based criteria disagreement. Adherence to established diagnostic guidelines is essential for accurate determination of mTBI history and for understanding the extent to which mTBI symptoms resolve or persist over time in OIF/OEF Veterans.The Journal of Rehabilitation Research and Development 06/2014; 51(3):363-376. DOI:10.1682/JRRD.2013.05.0115 · 1.69 Impact Factor
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ABSTRACT: Objective: To identify promising practices in educational service delivery. Methods: Consensus-building process with a multidisciplinary group of researchers, policy makers, and state Department of Education personnel. Results: This white paper presents the group's consensus on the essential components of a statewide educational infrastructure to support students with traumatic brain injury across the spectrum of injury severity: (a) identification, screening, and assessment practices; (b) systematic communication between medical and educational systems; (c) tracking of child's progress over time; and (d) professional development for school personnel. The white paper also presents key outcomes for measuring success and provides recommendations both for policy change and for furthering research in childhood brain injury. Key words: education, interventions, school children, special education, traumatic brain injury I N AUGUST 2011, the Summit on Childhood Brain Injury was held at State College, Pennsylvania, to develop recommendations for building statewide capac-ity to support students with brain injury in educational settings. The Health Resource Services Administration (HRSA) Traumatic Brain Injury (TBI) Program within Author Affiliations:, and the National Children's Collaborative on Brain Injury.Intelligent Transportation Systems Journal 01/2014; 29(3):224-232.