Citation

Pape TL, Smith B, Babcock-Parziale J, Evans CT, Herrold AA, Phipps Maieritsch K, High WM. Arch. Phys. Med. Rehabil. 2018; 99(7): 1370-1382.

Affiliation

Neuropsychologist, Lexington VAMC C-306; University of Kentucky College of Medicine, Departments of Physical Medicine and Rehabilitation, Neurosurgery, & Psychology.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.apmr.2017.11.017

PMID

29355506

Abstract

OBJECTIVE: To comprehensively estimate the diagnostic accuracy and reliability of the Department of Veterans Affairs (VA) TBI Clinical Reminder Screen (TCRS).

DESIGN: Cross-sectional, prospective, observational study using the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. SETTING: Three VA Polytrauma Network Sites. PARTICIPANTS: 433 Operation Iraqi Freedom, Operation Enduring Freedom (OEF/OIF) Veterans. MAIN OUTCOME MEASURES: TCRS, Comprehensive TBI Evaluation (CTBIE), Structured TBI Diagnostic Interview (STDI), Symptom Attribution and Classification Algorithm (SACA), Clinician-Administered PTSD Scale (CAPS).

RESULTS: 45% of Veterans screened positive on the TCRS for TBI. For detecting occurrence of historical TBI, the TCRS had 0.56-0.74 sensitivity (Se), 0.63-0.93 specificity (Sp), 25-45% Positive Predictive Value (PPV), 91-94% Negative Predictive Value (NPV), and 4-13 diagnostic odds ratio (DOR). For accuracy of attributing active symptoms to the TBI, the TCRS had 0.64-0.87 Se, 0.59-0.89 Sp, 26-32% PPV, 92-95% NPV, and 6-9 DOR. The Se was higher for Veterans with PTSD (0.80-0.86) relative to Veterans without PTSD (0.56-0.82). The Sp, however, was higher among Veterans without PTSD (0.75-0.90) relative to Veterans with PTSD (0.36-0.73). 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 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 following possible mTBI would improve diagnostic accuracy.

Copyright © 2018. Published by Elsevier Inc.

Language: en

Keywords

Diagnostic Accuracy; Mass Screening; Sensitivity; Specificity; Traumatic Brain Injury; Veterans