TY  - JOUR
PY  - 2018//
TI  - Diagnostic accuracy of the Veteran Affairs' Traumatic Brain Injury Screen
JO  - Archives of physical medicine and rehabilitation
A1  - Pape, Theresa Louise-Bender
A1  - Smith, Bridget
A1  - Babcock-Parziale, Judith
A1  - Evans, Charlesnika T.
A1  - Herrold, Amy A.
A1  - Phipps Maieritsch, Kelly
A1  - High, Walter M.
SP  - 1370
EP  - 1382
VL  - 99
IS  - 7
N2  - OBJECTIVE: To comprehensively estimate the diagnostic accuracy and reliability of the Department of Veterans Affairs (VA) TBI Clinical Reminder Screen (TCRS). <br><br>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). <br><br>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. <br><br>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.<br><br>Copyright © 2018. Published by Elsevier Inc.<p />  <p>Language: en</p>
LA  - en
SN  - 0003-9993
UR  - http://dx.doi.org/10.1016/j.apmr.2017.11.017
ID  - ref1
ER  -