Abstract
Objective
To comprehensively estimate the diagnostic accuracy and reliability of the Department
of Veterans Affairs (VA) Traumatic Brain Injury (TBI) Clinical Reminder Screen (TCRS).
Design
Cross-sectional, prospective, observational study using the Standards for Reporting
of Diagnostic Accuracy criteria.
Setting
Three VA Polytrauma Network Sites.
Participants
Operation Iraqi Freedom, Operation Enduring Freedom veterans (N=433).
Main Outcome Measures
TCRS, Comprehensive TBI Evaluation, Structured TBI Diagnostic Interview, Symptom Attribution
and Classification Algorithm, and Clinician-Administered Posttraumatic Stress Disorder
(PTSD) Scale.
Results
Forty-five percent of veterans screened positive on the TCRS for TBI. For detecting
occurrence of historical TBI, the TCRS had a sensitivity of .56 to .74, a specificity
of .63 to .93, a positive predictive value (PPV) of 25% to 45%, a negative predictive
value (NPV) of 91% to 94%, and a diagnostic odds ratio (DOR) of 4 to 13. For accuracy
of attributing active symptoms to the TBI, the TCRS had a sensitivity of .64 to .87,
a specificity of .59 to .89, a PPV of 26% to 32%, an NPV of 92% to 95%, and a DOR
of 6 to 9. The sensitivity was higher for veterans with PTSD (.80–.86) relative to
veterans without PTSD (.57–.82). The specificity, however, was higher among veterans
without PTSD (.75–.81) relative to veterans with PTSD (.36–.49). All indices of diagnostic
accuracy changed when participants with questionably valid (QV) test profiles were
eliminated from analyses.
Conclusions
The utility of the TCRS to screen for mild TBI (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 after possible mTBI would improve diagnostic
accuracy.
Keywords
List of abbreviations:
AOC (alteration of consciousness), BTBIS (Brief Traumatic Brain Injury Screen), CAPS (Clinician-Administered PTSD Scale), CTBIE (Comprehensive TBI Evaluation), DOR (diagnostic odds ratio), LOC (loss of consciousness), mTBI (mild traumatic brain injury), NPV (negative predictive value), OEF/OIF (Operation Enduring Freedom and Operation Iraqi Freedom), PCL (PTSD Checklist), PCL-M (PTSD Checklist–Military), PPV (positive predictive value), PTSD (posttraumatic stress disorder), QV (questionably valid), SACA (Symptom Attribution and Classification Algorithm), STDI (Structured TBI Diagnostic Interview), TBI (traumatic brain injury), TCRS (TBI Clinical Reminder Screen), VA (Veterans Affairs)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 17, 2018
Footnotes
Supported by a Service-Directed Research Award (no. 08-377) from the United States Department of Veterans Affairs Health Services Research and Development Service. The contents of this manuscript do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
