Study Finds High TBI Screening Rates among OEF/OIF Veterans
BACKGROUND:
It is estimated that 15 to 20% of U.S. military personnel deployed to Iraq and Afghanistan have suffered mild traumatic brain injury (TBI) during deployment. To identify OEF/OIF Veterans who may benefit from healthcare services, VA implemented a national clinical reminder in April 2007 to screen for TBI. This screen is mandatory and is administered to all OEF/OIF Veterans during their initial VA visit. The TBI screen is administered verbally and includes four sections that address: 1) TBI-related exposure during deployment (e.g., blast, vehicular accidents); 2) presence of symptoms immediately after an exposure; 3) manifestation of new symptoms or worsening of immediate symptoms; and 4) symptoms at the time TBI screening is completed. This national, retrospective cohort study describes the early results of VA's TBI screening program, and identifies patient and facility characteristics associated with receiving a TBI screen. Using VA administrative data, investigators identified 170,681 OEF/OIF Veterans who sought care at VA medical centers (inpatient and/or outpatient) from 4/07 through 9/08. Investigators also examined patient demographics, other diagnoses, VA enrollment priority status, prior healthcare utilization, and facility characteristics.
FINDINGS:
- TBI screening rates are high in VA, with more than 90% of eligible Veterans screened
- Of Veterans who were screened, 21% met the VA definition of a positive screen, with blast or explosion the most common exposure reported.
- Factors associated with a positive TBI screen included: male gender, having served in the Army, having had multiple deployments, and having mental health diagnoses in the previous year.
- A positive TBI screen was less likely among Veterans who were separated from duty for more than 18 months, or Veterans who had a chronic disease diagnosis.
- The most common symptoms reported in the period after injury were sleep problems (78%), irritability (69%), and headaches (63%), and these symptoms continued to be current problems at time of screening.
LIMITATIONS:
- Findings are based on administrative data, thus there may be errors in reporting of screening results as well as other characteristics.
- Data focus only on the first 18 months after the TBI screen was implemented; more recent data may show different results.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (SDR 08-409). All authors except Dr. Steiner are part of HSR&D's Center for Management of Complex Chronic Care, Hines, IL. Drs. Evans, Hogan, Weaver, and Smith also are part of VA/HSR&D's Spinal Cord Injury Quality Enhancement Research Initiative (SCI-QUERI).
Evans C, St. Andre J, Pape T, Steiner M, Stroupe K, Hogan T, Weaver F, and Smith B. An Evaluation of the VA TBI Screening Process among OEF/OIF Veterans. PM&R March 2013;5(3):210-20.
