Journal
JOURNAL OF NEUROTRAUMA
Volume 38, Issue 22, Pages 3126-3136Publisher
MARY ANN LIEBERT, INC
DOI: 10.1089/neu.2021.0031
Keywords
chronic pain; concussion; post-concussion syndrome; sleep; traumatic brain injury
Funding
- Office of the Assistant Secretary of Defense for Health Affairs [W81XWH-17-1-0423]
- VA Career Development Award [1K2 BX002712, 1K2 RX002947]
- Portland VA Research Foundation
- NIH [T32 AT002688, TL1TR002371]
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This study examined the effectiveness of different methods for evaluating history of traumatic brain injury (TBI), finding that the Head Trauma Events Characteristics (HTEC) method had the highest sensitivity. It also noted that the results and conclusions may significantly differ depending on the diagnostic method used.
Common methods for evaluating history of traumatic brain injury (TBI) include self-report, electronic medical record review (EMR), and structured interviews such as the Head Trauma Events Characteristics (HTEC). Each has strengths and weaknesses, but little is known regarding how TBI diagnostic rates or the associated symptom profile differ among them. This study examined 200 Veterans recruited within the VA Portland Health Care System, each evaluated for TBI using self-report, EMR, and HTEC. Participants also completed validated questionnaires assessing chronic symptom severity in broad health-related domains (pain, sleep, quality of life, post-concussive symptoms). The HTEC was more sensitive (80% of participants in our cohort) than either self-report or EMR alone (40%). As expected from the high sensitivity, participants screening positive for TBI through the HTEC included many people with mild or no post-concussive symptoms. Participants were grouped according to degree of concordance across these diagnostic methods: no TBI, n = 43; or TBI-positive in any one method (TBI-1dx, n = 53), positive in any two (TBI-2dx, n = 45), or positive in all three (TBI-3dx, n = 59). The symptom profile of the TBI-1dx group was indistinguishable from the no TBI group. The TBI-3dx group had the most severe symptom profile. Our results show that understanding the exact methods used to ascertain TBI is essential when interpreting results from other studies, given that results and conclusions may differ dramatically depending on the method. This issue will become even more critical when interpreting data merged from multiple sources within newer, centralized repositories (e.g., Federal Interagency Traumatic Brain Injury Research [FITBIR]).
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