Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MA-MIRECC), Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, USA.
Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
J Neurotrauma. 2023 Nov;40(21-22):2321-2329. doi: 10.1089/neu.2023.0067. Epub 2023 Jun 2.
Evaluating large data sets precludes the ability to directly measure individual experiences, instead relying on proxies to infer certain constructs. Blast exposure is a construct of study currently in its infancy, resulting in diverse definitions and measurements across studies. The purpose of the present study was to validate military occupational specialty (MOS) as a proxy for blast exposure in combat veterans. A total of 256 veterans (86.33% male) completed the Salisbury Blast Interview (SBI) and Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC) Assessment of Traumatic Brain Injury (MMA-TBI). MOS was collected through record review and categorized into low and high risk for blast exposure. Chi-square analyses and tests compared SBI metrics between MOS categories. Receiver operating characteristic (ROC) analyses evaluated the diagnostic accuracy of MOS category in determining blast exposure severity. Veterans in high-risk MOS were more likely to have experienced blast and deployment TBI (s < 0.001) than were those in low-risk MOS. ROC analyses indicated good specificity (81.29-88.00) for blast and deployment TBI outcomes, suggesting that low-risk MOS is generally associated with an absence of blast and deployment TBI outcomes. Sensitivity was low (36.46-51.14), indicating that MOS risk level was not a good predictor of the presence of these outcomes. Results demonstrate that high-risk MOSs will identify individuals with blast exposure and deployment TBI history whereas low-risk MOSs will capture a highly variable group. Accuracy of MOS categorization was not acceptable for diagnostic-level tests; however, results support its use as a screening measure for a history of exposure to blast, use in epidemiological studies, and considerations for military policy.
评估大型数据集排除了直接测量个体经验的能力，而是依赖于替代指标来推断某些结构。爆炸暴露是目前研究的一个结构，导致研究之间存在不同的定义和测量。本研究的目的是验证军事职业专业（MOS）作为战斗退伍军人爆炸暴露的替代指标。共有 256 名退伍军人（86.33%为男性）完成了索尔兹伯里爆炸访谈（SBI）和中大西洋心理疾病研究教育和临床中心（MIRECC）创伤性脑损伤评估（MMA-TBI）。MOS 通过记录审查收集，并分为低风险和高风险爆炸暴露。卡方分析和 t 检验比较 MOS 类别之间的 SBI 指标。接收者操作特征（ROC）分析评估 MOS 类别在确定爆炸暴露严重程度方面的诊断准确性。高风险 MOS 的退伍军人更有可能经历过爆炸和部署性脑外伤（s<0.001），而低风险 MOS 的退伍军人则较少。ROC 分析表明，爆炸和部署性脑外伤结果的特异性良好（81.29-88.00），这表明低风险 MOS 通常与不存在爆炸和部署性脑外伤结果相关。敏感性较低（36.46-51.14），这表明 MOS 风险水平不是这些结果存在的良好预测指标。结果表明，高风险 MOS 将确定有爆炸暴露和部署性脑外伤史的个体，而低风险 MOS 将捕获高度可变的群体。MOS 分类的准确性不能满足诊断水平测试的要求；然而，结果支持其作为爆炸暴露史的筛选指标的使用，在流行病学研究中的使用，以及对军事政策的考虑。
