Fortier Catherine Brawn, Amick Melissa M, Kenna Alexandra, Milberg William P, McGlinchey Regina E
Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, Massachusetts (Drs Fortier, Amick, Kenna, Milberg, and McGlinchey); Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts (Drs Fortier, Milberg, and McGlinchey); Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (Drs Fortier, Milberg, and McGlinchey); and Department of Psychiatry, Boston University Medical School, Boston, Massachusetts (Dr Amick).
J Head Trauma Rehabil. 2015 Jan-Feb;30(1):E1-7. doi: 10.1097/HTR.0000000000000008.
Mild traumatic brain injury is the signature injury of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND), yet its identification and diagnosis is controversial and fraught with challenges.
In 2007, the Department of Veterans Affairs (VA) implemented a policy requiring traumatic brain injury (TBI) screening on all individuals returning from deployment in the OEF/OIF/OND theaters of operation that lead to the rapid and widespread use of the VA TBI screen. The Boston Assessment of TBI-Lifetime (BAT-L) is the first validated, postcombat semistructured clinical interview to characterize head injuries and diagnose TBIs throughout the life span, including prior to, during, and post-military service.
Community-dwelling convenience sample of 179 OEF/OIF/OND veterans.
BAT-L, VA TBI screen.
Based on BAT-L diagnosis of military TBI, the VA TBI screen demonstrated similar sensitivity (0.85) and specificity (0.82) when administered by research staff. When BAT-L diagnosis was compared with historical clinician-administered VA TBI screen in a subset of participants, sensitivity was reduced.
The specificity of the research-administered VA TBI screen was more than adequate. The sensitivity of the VA TBI screen, although relatively high, suggests that it does not oversample or "catch all" possible military TBIs. Traumatic brain injuries identified by the BAT-L, but not identified by the VA TBI screen, were predominantly noncombat military injuries. There is potential concern regarding the validity and reliability of the clinician administered VA TBI screen, as we found poor correspondence between it and the BAT-L, as well as low interrater reliability between the clinician-administered and research-administered screen.
轻度创伤性脑损伤是持久自由行动（OEF）、伊拉克自由行动（OIF）和新黎明行动（OND）的标志性损伤，但其识别和诊断存在争议且充满挑战。
2007年，退伍军人事务部（VA）实施了一项政策，要求对所有从OEF/OIF/OND行动战区部署归来的人员进行创伤性脑损伤（TBI）筛查，这导致VA TBI筛查迅速广泛应用。波士顿创伤性脑损伤终身评估（BAT-L）是首个经过验证的、战后半结构化临床访谈，用于描述一生当中的头部损伤并诊断TBI，包括军事服役之前、期间和之后。
179名OEF/OIF/OND退伍军人的社区居住便利样本。
BAT-L、VA TBI筛查。
基于BAT-L对军事TBI的诊断，当由研究人员进行筛查时，VA TBI筛查显示出相似的敏感性（0.85）和特异性（0.82）。在一部分参与者中，将BAT-L诊断与历史上由临床医生进行的VA TBI筛查相比较时，敏感性降低。
研究人员进行的VA TBI筛查的特异性足够高。VA TBI筛查的敏感性虽然相对较高，但表明它没有过度抽样或“涵盖所有”可能的军事TBI。BAT-L识别出但VA TBI筛查未识别出的创伤性脑损伤主要是非战斗性军事损伤。对于临床医生进行的VA TBI筛查的有效性和可靠性存在潜在担忧，因为我们发现它与BAT-L之间的一致性较差，并且临床医生进行的筛查和研究人员进行的筛查之间的评分者间信度较低。
