Diagnostic Accuracy of the Veteran Affairs' Traumatic Brain Injury Screen.
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 cri...
| Publicado en: | Archives of Physical Medicine & Rehabilitation Vol. 99; no. 7; pp. 1370 - 1383 |
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| Autores principales: | , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
W B Saunders
Jul2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=130301583&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 130301583 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00039993 1XL jtl: Archives of Physical Medicine & Rehabilitation issn: 00039993 maglogo: N pubinfo: dt: Jul2018 vid: 99 iid: 7 pid: 1351 pub: W B Saunders place: Philadelphia, Pennsylvania artinfo: ui: 130301583 130301583 130301583 10.1016/j.apmr.2017.11.017 130301583 ppf: 1370 ppct: 13 formats: tig: atl: Diagnostic Accuracy of the Veteran Affairs' Traumatic Brain Injury Screen. aug: au: Pape, Theresa Louise Bender Smith, Bridget Babcock-Parziale, Judith Evans, Charlesnika T. Herrold, Amy A. Phipps Maieritsch, Kelly Jr.High, Walter M. affil: Department of Veterans Affairs (VA), Research Service, Edward Hines Jr. VA Hospital, Hines, IL sug: subj: Brain Injuries Diagnosis Neuropsychological Tests Instrument Validation Human Cross Sectional Studies Prospective Studies Nonexperimental Studies Hospitals, Veterans Multicenter Studies Validation Studies Veterans Structured Interview Sensitivity and Specificity Predictive Value of Tests Descriptive Statistics Odds Ratio Stress Disorders, Post-Traumatic Diagnosis ab: 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. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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