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McIntire A, Miller T, Thapa S, Joseph A, Carlson KF, Reavis KM, Hughes CK. Blast Exposure Associations With Hearing Loss and Self-Reported Hearing Difficulty. Otolaryngol Head Neck Surg 2024. [PMID: 38984918 DOI: 10.1002/ohn.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/03/2024] [Accepted: 05/12/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Examine associations between military blast exposures on hearing loss and self-reported hearing difficulties among Active-Duty Service Members (ADSM) and Veterans from the Noise Outcomes in Servicemembers Epidemiology (NOISE) study. STUDY DESIGN Cross-sectional. SETTING Multi-institutional tertiary referral centers. METHODS Blast exposure was assessed with a comprehensive blast questionnaire. Outcome measures included pure-tone hearing thresholds; Speech Recognition in Noise Test; Hearing Handicap Inventory for Adults (HHIA); and Speech, Spatial and Qualities of Hearing Scale (SSQ)-12. RESULTS Twenty-one percent (102/494) of ADSM and 36.8% (196/533) of Veterans self-reported blast exposure. Compared to ADSM without blast exposure, blast-exposed ADSM had increased odds of high frequency (3-8 kHz) and extended-high frequency (9-16 kHz) hearing loss (odds ratio [OR] = 2.5, CI: 1.3, 4.7; OR = 3.7, CI: 1.9, 7.0, respectively). ADSM and Veterans with blast exposure were more likely than their nonblast exposed counterparts to report hearing difficulty on the HHIA (OR = 1.9, CI: 1.1, 3.3; OR = 2.1, CI: 1.4, 3.2, respectively). Those with self-reported blast exposure also had lower SSQ-12 scores (ADSM mean difference = -0.6, CI: -1.0, -0.1; Veteran mean difference: -0.9, CI: -1.3, -0.5). CONCLUSION Results suggest that blast exposure is a prevalent source of hearing injury in the military. We found that among ADSM, blast exposure was associated with hearing loss, predominately in the higher frequencies. Blast exposure was associated with poorer self-perceived hearing ability in ADSM and Veterans. IRB: #FWH20180143H Joint Base San Antonio (JBSA) Military Healthcare System; #3159/9495 Joint VA Portland Health Care System (VAPORHCS) Oregon Health and Science University (OHSU).
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Affiliation(s)
- Aaron McIntire
- Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California, USA
| | - Tanner Miller
- Department of Otolaryngology, Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
| | - Samrita Thapa
- VA RR&D, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon, USA
| | - Antony Joseph
- Hearing Loss Prevention Laboratory, Communication Sciences and Disorders, Illinois State University, Normal, Illinois, USA
| | - Kathleen F Carlson
- VA RR&D, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA
- VA HSR&D, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Kelly M Reavis
- VA RR&D, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Charlotte K Hughes
- Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California, USA
- Department of Otolaryngology, University of California San Diego, San Diego, California, USA
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Hughes CK, Thapa S, Theodoroff SM, Carlson KF, Schultz JD, Grush LD, Reavis KM. Military and Nonmilitary TBI Associations with Hearing Loss and Self-Reported Hearing Difficulty among Active-Duty Service Members and Veterans. Otol Neurotol 2024; 45:e147-e155. [PMID: 38361292 DOI: 10.1097/mao.0000000000004103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Identify associations between self-reported history of military and nonmilitary traumatic brain injury (TBI) on hearing loss and hearing difficulty from the Noise Outcomes in Servicemembers Epidemiology (NOISE) study. STUDY DESIGN Cross-sectional. SETTING Multi-institutional tertiary referral centers. PATIENTS Four hundred seventy-three Active-Duty Service members (ADSM) and 502 veterans. EXPOSURE Self-reported history of no TBI, military TBI only, nonmilitary TBI only, both military and nonmilitary TBI. MAIN OUTCOME MEASURES Pure-tone hearing thresholds, Speech Recognition In Noise Test (SPRINT), Hearing Handicap Inventory for Adults (HHIA), and Speech, Spatial and Qualities of Hearing Scale (SSQ)-12. RESULTS 25% (120/473) of ADSM and 41% (204/502) of veterans self-reported a TBI. Military TBI was associated with poorer hearing thresholds in all frequency ranges in veterans (adjusted mean difference, 1.8 dB; 95% confidence interval [CI], 0.5-3.0; 3.3, 0.8-5.8; 5.1; 1.7-8.5, respectively), and in the high frequency range in ADSM (mean difference, 3.2 dB; 95% CI, 0.1-6.3). Veterans with military TBI only and nonmilitary TBI only had lower odds of correctly identifying speech in noise than veterans with no TBI (odds ratio [OR], 0.78; 95% CI, 0.72-0.83; 0.90; 0.84-0.98). ADSM with a military TBI (OR, 5.7; 95% CI, 2.6-12.5) and veterans with any TBI history (OR, 2.5; 95% CI, 1.5-4.3; OR, 2.2; 95% CI, 1.3-3.8; OR, 4.5; 95% CI, 2.1-9.8) were more likely to report hearing difficulty on HHIA. SSQ-12 results corroborated HHIA findings. CONCLUSIONS Military TBI was associated with poorer hearing thresholds in veterans and ADSM, and poorer SPRINT scores in veterans. Military TBI was associated with poorer self-perceived hearing ability in ADSM. All types of TBI were associated with poorer self-perceived hearing ability in veterans, although the strength of this association was greatest for military TBI.
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Affiliation(s)
| | | | | | | | - James D Schultz
- DoD Hearing Center of Excellence, Defense Health Agency, San Antonio, TX
| | - Leslie D Grush
- VA RR&D, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR
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Lewis MS, Reavis KM, Griest S, Carlson KF, Gordon J, Henry JA. The influence of tinnitus and hearing loss on the functional status of military Service members and Veterans. Int J Audiol 2023; 62:44-52. [PMID: 35819808 DOI: 10.1080/14992027.2021.2017494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study evaluated the influence of tinnitus and hearing loss on the functional status of military Service members and Veterans. DESIGN Participants completed audiologic testing and self-report instruments to assess tinnitus, hearing, and general functioning. We conducted multiple linear regression analyses using cross-sectional data with functional status as the dependent variable. The primary independent variables were tinnitus and average low-, high-, and extended high-frequency hearing thresholds. Secondary independent variables were subjective tinnitus severity and hearing difficulties. Each of the independent variables was modelled separately for Service members and Veterans; covariates for each multivariable model were identified a priori and, depending on the association being modelled, included age, gender, blast-wave exposure, and history of military traumatic brain injury. STUDY SAMPLE Data were analysed from 283 Service members and 390 Veterans. RESULTS After controlling for potential confounders, presence of tinnitus, tinnitus severity, average low-frequency hearing thresholds, and subjective hearing difficulties were significantly associated with functional status in Service members and Veterans. CONCLUSIONS These results suggest that tinnitus and poorer low-frequency hearing, and the perceived severity of tinnitus and hearing difficulties, may be associated with poorer functional status among Service members and Veterans.
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Affiliation(s)
- M Samantha Lewis
- Veterans Affairs (VA) Rehabilitation Research & Development (RR&D) National Center for Rehabilitative Auditory Research, VA Portland Health Care System (VAPORHCS), Portland, OR, USA.,School of Audiology, Pacific University, Hillsboro, OR, USA.,Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Kelly M Reavis
- Veterans Affairs (VA) Rehabilitation Research & Development (RR&D) National Center for Rehabilitative Auditory Research, VA Portland Health Care System (VAPORHCS), Portland, OR, USA.,OHSU-Portland State University School of Public Health, OHSU, Portland, OR, USA
| | - Susan Griest
- Veterans Affairs (VA) Rehabilitation Research & Development (RR&D) National Center for Rehabilitative Auditory Research, VA Portland Health Care System (VAPORHCS), Portland, OR, USA.,Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Kathleen F Carlson
- Veterans Affairs (VA) Rehabilitation Research & Development (RR&D) National Center for Rehabilitative Auditory Research, VA Portland Health Care System (VAPORHCS), Portland, OR, USA.,OHSU-Portland State University School of Public Health, OHSU, Portland, OR, USA.,Center to Improve Veteran Involvement in Care, VAPORHCS, Portland, OR, USA
| | - Jane Gordon
- Veterans Affairs (VA) Rehabilitation Research & Development (RR&D) National Center for Rehabilitative Auditory Research, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
| | - James A Henry
- Veterans Affairs (VA) Rehabilitation Research & Development (RR&D) National Center for Rehabilitative Auditory Research, VA Portland Health Care System (VAPORHCS), Portland, OR, USA.,Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR, USA
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4
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Zogas A. "We have no magic bullet": Diagnostic ideals in veterans' mild traumatic brain injury evaluations. PATIENT EDUCATION AND COUNSELING 2022; 105:654-659. [PMID: 34127333 DOI: 10.1016/j.pec.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To understand military veterans' and healthcare providers' experiences identifying veterans' personal histories of combat-related mild traumatic brain injury (mTBI) months or years after the injury. METHODS Patients and clinical staff of a Veterans Health Administration (VA) Polytrauma/TBI clinic participated in a seven-month ethnographic study, which combined direct observation and interviews with veterans (n = 12) and VA clinicians (n = 11). Data were analyzed thematically. RESULTS Veterans and staff have different understandings of the value of neuroimaging in care for patients with post-acute mTBI, and different understandings of the role of diagnostic certainty in clinical care. Veterans sought to understand the relationship between their past head injuries and their current symptoms. Clinicians educated veterans that their symptoms could be caused by multiple factors and embraced ambiguity as part of treating this patient population. CONCLUSIONS Patient-provider communication may be enhanced by conversations about common norms of diagnosis and why evaluating mTBI histories departs from these norms. PRACTICE IMPLICATIONS Clinicians should anticipate that patients may expect a diagnostic process that entails neuroimaging and resolves their uncertainty. In the case of post-acute mTBI, patients would likely benefit from education about the diagnostic process, itself.
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Affiliation(s)
- Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.
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Ozturk ED, Chanfreau-Coffinier C, Sakamoto MS, Delano-Wood L, Merritt VC. Characterization of Million Veteran Program (MVP) enrollees with Comprehensive Traumatic Brain Injury Evaluation (CTBIE) data: An analysis of neurobehavioral symptoms. J Psychiatr Res 2021; 145:230-242. [PMID: 34942434 PMCID: PMC9401093 DOI: 10.1016/j.jpsychires.2021.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/19/2021] [Accepted: 12/11/2021] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to examine neurobehavioral symptom reporting in a large sample of military veterans (N = 12,144) who completed the Comprehensive Traumatic Brain Injury Evaluation (CTBIE) and enrolled in the VA's Million Veteran Program (MVP). The CTBIE is a clinician-administered interview that assesses for historical, deployment-related traumatic brain injury (TBI) and evaluates symptoms using the Neurobehavioral Symptom Inventory (NSI). Clinicians completing the CTBIE made clinical determinations about participants' (1) TBI diagnostic status (i.e., CTBIE+ or CTBIE-) and (2) current symptom etiology (i.e., Symptom Resolution, TBI, Behavioral Health, Comorbid TBI + Behavioral Health [Comorbid], or Other). We evaluated the association of TBI diagnostic status and symptom etiology group with neurobehavioral symptoms. Results showed a significant association between TBI diagnostic status and all NSI variables, with CTBIE+ veterans endorsing greater symptoms than CTBIE- veterans. There was also a significant association between symptom etiology group and all NSI variables; specifically, the Comorbid and Behavioral Health groups generally endorsed significantly greater symptoms compared to the other groups. Follow-up analyses showed that relative to the Symptom Resolution group, the Comorbid and Behavioral Health groups had increased odds of severe/very severe cognitive and affective symptoms, whereas the TBI and Other groups did not. Finally, presence of psychiatric symptoms, pain, post-traumatic amnesia, loss of consciousness, and blast exposure significantly predicted Comorbid symptom etiology group membership. Findings from this large epidemiologic MVP study have relevant clinical implications and further highlight the importance of prioritizing integrated behavioral health interventions for this vulnerable population.
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Affiliation(s)
- Erin D Ozturk
- San Diego State University/University of California, San Diego Joint Doctoral Program, San Diego, CA, United States
| | - Catherine Chanfreau-Coffinier
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - Lisa Delano-Wood
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
| | - Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States.
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Moriarty H, Robinson KM, Winter L. The additional burden of PTSD on functioning and depression in veterans with traumatic brain injury. Nurs Outlook 2021; 69:167-181. [PMID: 33608113 DOI: 10.1016/j.outlook.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many United States veterans and active military with a history of traumatic brain injury (TBI) also experience challenges from comorbid posttraumatic stress disorder (PTSD), yet the additional burden of PTSD is not clear. PURPOSE To address this knowledge gap, this study examined the relationship of PTSD to cognitive, social, and physical functioning and depressive symptoms in veterans recently diagnosed with TBI. METHODS Veterans were recruited from a VA rehabilitation clinic. The Patient Competency Rating Scale and Center for Epidemiologic Studies Depression Scale measured functioning and depression, respectively. Chart review captured PTSD diagnosis. FINDINGS In the sample of 83 veterans, 65% had a current PTSD diagnosis. After controlling for sociodemographic variables and TBI severity, PTSD was a significant predictor of lower cognitive, social, and physical functioning and higher depressive symptomatology. DISCUSSION Clinicians should incorporate PTSD assessment in their work with veterans with TBI. Integrated behavioral health and rehabilitation interventions that provide strategies for veterans to manage TBI symptoms and PTSD are critical.
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Affiliation(s)
- Helene Moriarty
- Villanova University, M. Louise Fitzpatrick College of Nursing, Villanova, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Nursing Service, Philadelphia, PA.
| | - Keith M Robinson
- University of Pennsylvania, Perelman School of Medicine, Department of Physical Medicine and Rehabilitation, Philadelphia, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Rehabilitation Medicine Service, Philadelphia, PA
| | - Laraine Winter
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Nursing Service, Philadelphia, PA
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Gray M, Adamson MM, Thompson RC, Kapphahn KI, Han S, Chung JS, Harris OA. Sex differences in symptom presentation and functional outcomes: a pilot study in a matched sample of veterans with mild TBI. Brain Inj 2020; 34:535-547. [DOI: 10.1080/02699052.2020.1725979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Max Gray
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | - Maheen M. Adamson
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | - Ryan C. Thompson
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | | | - Summer Han
- Department of Neurosurgery, Stanford School of Medicine, Palo Alto, CA, USA
| | - Joyce S. Chung
- Department of Polytrauma, VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | - Odette A. Harris
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
- Department of Neurosurgery, Stanford School of Medicine, Palo Alto, CA, USA
- Department of Polytrauma, VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
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8
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Predictors of Employment Status in Male and Female Post-9/11 Veterans Evaluated for Traumatic Brain Injury. J Head Trauma Rehabil 2019; 34:11-20. [DOI: 10.1097/htr.0000000000000404] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Suri P, Stolzmann K, Williams R, Pogoda TK. Deployment-Related Traumatic Brain Injury and Risk of New Episodes of Care for Back Pain in Veterans. THE JOURNAL OF PAIN 2019; 20:97-107. [DOI: 10.1016/j.jpain.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/30/2018] [Accepted: 08/14/2018] [Indexed: 01/22/2023]
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Cota MR, Moses AD, Jikaria NR, Bittner KC, Diaz-Arrastia RR, Latour LL, Turtzo LC. Discordance between Documented Criteria and Documented Diagnosis of Traumatic Brain Injury in the Emergency Department. J Neurotrauma 2018; 36:1335-1342. [PMID: 30351183 DOI: 10.1089/neu.2018.5772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Accurate diagnosis of traumatic brain injury (TBI) is critical to ensure that patients receive appropriate follow-up care, avoid risk of subsequent injury, and are aware of possible long-term consequences. However, diagnosis of TBI, particularly in the emergency department (ED), can be difficult because the symptoms of TBI are vague and nonspecific, and patients with suspected TBI may present with additional injuries that require immediate medical attention. We performed a retrospective chart review to evaluate accuracy of TBI diagnosis in the ED. Records of 1641 patients presenting to the ED with suspected TBI and a head computed tomography (CT) were reviewed. We found only 47% of patients meeting the American Congress of Rehabilitation Medicine criteria for TBI received a documented ED diagnosis of TBI in medical records. After controlling for demographic and clinical factors, patients presenting at a level I trauma center, with cause of injury other than fall, without CT findings of TBI, and without loss of consciousness were more likely to lack documented diagnosis despite meeting diagnostic criteria for TBI. A greater proportion of patients without documented ED diagnosis of TBI were discharged home compared to those with a documented diagnosis of TBI (58% vs. 40%; p < 0.001). Together, these data suggest that many patients who have sustained a TBI are discharged home from the ED without a documented diagnosis of TBI, and that improved awareness and implementation of diagnostic criteria for TBI is important in the ED and for in- and outpatient providers.
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Affiliation(s)
- Martin R Cota
- 1 Stroke Diagnostics and Therapeutics Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,2 Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland
| | - Anita D Moses
- 1 Stroke Diagnostics and Therapeutics Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,2 Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland
| | - Neekita R Jikaria
- 1 Stroke Diagnostics and Therapeutics Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,2 Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland
| | - Katie C Bittner
- 2 Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland
| | | | - Lawrence L Latour
- 1 Stroke Diagnostics and Therapeutics Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,2 Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland
| | - L Christine Turtzo
- 1 Stroke Diagnostics and Therapeutics Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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11
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Belanger HG, Vanderploeg RD, Sayer N. Screening for Remote History of Mild Traumatic Brain Injury in VHA: A Critical Literature Review. J Head Trauma Rehabil 2018; 31:204-14. [PMID: 26394295 DOI: 10.1097/htr.0000000000000168] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The authors reviewed the existing literature on the Veterans Health Administration's (VHA's) traumatic brain injury (TBI) screening and evaluation program to provide a qualitative synthesis and critical review of results focusing on the psychometric properties of the screen. METHODS All studies of the VHA's screening and evaluation process were reviewed, both those involving primary data collection and those relying upon VHA data. Diagnostic statistics were summarized and also recalculated on the basis of a positive screening rate of 20%, the observed rate within the VHA, and an estimated population prevalence of TBI of 15% within the Department of Veterans Affairs (VHA). RESULTS The TBI screen within the VHA is administered to nearly every eligible patient. The majority of clinical presentations are deemed to be due to mental health and/or a combination of mental health and TBI factors. The screen has good internal consistency, variable test-retest reliability, and questionable validity, with poor agreement between the TBI screen and criterion standards overall. Studies based on nonrepresentative samples reported high sensitivity. Assuming the VHA's TBI screening rate of 20% in a hypothetical sample, sensitivity is poor (the screen misses 30%-60% of TBI cases). However, specificity remains adequate. Studies based on samples with high rates of TBI reported much higher positive predictive values (and slightly lower negative predictive values) than those observed when a hypothetical TBI prevalence of 15% was used. CONCLUSION Questions remain about the validity of the TBI screen. Future research should address the utility of screening for TBI.
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Affiliation(s)
- Heather G Belanger
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, Florida (Drs Belanger and Vanderploeg); Departments of Psychology and Psychiatry, University of South Florida, Tampa (Drs Belanger and Vanderploeg); Defense and Veterans Brain Injury Center, Tampa, Florida (Drs Belanger and Vanderploeg); Tampa HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research (CIDRR8), Tampa, Florida (Drs Belanger and Vanderploeg); Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota (Dr Sayer); and Departments of Medicine and Psychiatry, University of Minnesota, Minneapolis (Dr Sayer)
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12
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Prince C, Bruhns ME. Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology. Brain Sci 2017; 7:brainsci7080105. [PMID: 28817065 PMCID: PMC5575625 DOI: 10.3390/brainsci7080105] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/04/2022] Open
Abstract
Awareness of mild traumatic brain injury (mTBI) and persisting post-concussive syndrome (PCS) has increased substantially in the past few decades, with a corresponding increase in research on diagnosis, management, and treatment of patients with mTBI. The purpose of this article is to provide a narrative review of the current literature on behavioral assessment and management of patients presenting with mTBI/PCS, and to detail the potential role of neuropsychologists and rehabilitation psychologists in interdisciplinary care for this population during the acute, subacute, and chronic phases of recovery.
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Affiliation(s)
- Carolyn Prince
- JFK Johnson Rehabilitation Institute, Center for Brain Injuries, Edison, NJ 08820, USA.
| | - Maya E Bruhns
- Alta Bates Summit Medical Center, Oakland, CA 94609, USA.
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13
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Suri P, Stolzmann K, Iverson KM, Williams R, Meterko M, Yan K, Gormley K, Pogoda TK. Associations Between Traumatic Brain Injury History and Future Headache Severity in Veterans: A Longitudinal Study. Arch Phys Med Rehabil 2017; 98:2118-2125.e1. [PMID: 28483652 DOI: 10.1016/j.apmr.2017.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/29/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine whether traumatic brain injury (TBI) history is associated with worse headache severity outcomes. DESIGN Prospective cohort study. SETTING Department of Veterans Affairs (VA) outpatient clinics. PARTICIPANTS Veterans (N=2566) who completed a mail follow-up survey an average of 3 years after a comprehensive TBI evaluation (CTBIE). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The presence or absence of TBI, and TBI severity were evaluated by a trained clinician and classified according to VA/Department of Defense clinical practice guidelines. Headache severity was evaluated at both the baseline CTBIE assessment and 3-year follow-up using a 5-level headache score ranging from 0 ("none") to 4 ("very severe") based on headache-associated activity interference in the past 30 days. We examined associations of mild and moderate/severe TBI history, as compared to no TBI history, with headache severity in cross-sectional and longitudinal analyses, with and without adjustment for potential confounders. RESULTS Mean headache severity scores were 2.4 at baseline and 2.3 at 3-year follow-up. Mild TBI was associated with greater headache severity in multivariate-adjusted cross-sectional analyses (β [SE]=.61 [.07], P<.001), as compared with no TBI, but not in longitudinal analyses (β [SE]=.09 [.07], P=.20). Moderate/severe TBI was significantly associated with greater headache severity in both cross-sectional (β [SE]=.66 [.09], P<.001) and longitudinal analyses (β [SE]=.18 [.09], P=.04). CONCLUSIONS Headache outcomes are poor in veterans who receive VA TBI evaluations, irrespective of past TBI exposure, but significantly worse in those with a history of moderate/severe TBI. No association was found between mild TBI and future headache severity in veterans. Veterans with headache presenting for TBI evaluations, and particularly those with moderate/severe TBI, may benefit from further evaluation and treatment of headache.
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Affiliation(s)
- Pradeep Suri
- Division of Rehabilitation Care Services/Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
| | - Katherine M Iverson
- National Center for PTSD, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Rhonda Williams
- Division of Rehabilitation Care Services/Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Mark Meterko
- Veterans Health Administration, Office of Performance Measurement, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Kun Yan
- Department of Physical Medicine and Rehabilitation, Northern California VA Healthcare System, Sacramento, CA
| | - Katelyn Gormley
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
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Algorithm for Symptom Attribution and Classification Following Possible Mild Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:E10-E22. [DOI: 10.1097/htr.0000000000000220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Associations Between Traumatic Brain Injury, Suspected Psychiatric Conditions, and Unemployment in Operation Enduring Freedom/Operation Iraqi Freedom Veterans. J Head Trauma Rehabil 2016; 31:191-203. [DOI: 10.1097/htr.0000000000000092] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kulbe JR, Geddes JW. Current status of fluid biomarkers in mild traumatic brain injury. Exp Neurol 2016; 275 Pt 3:334-352. [PMID: 25981889 PMCID: PMC4699183 DOI: 10.1016/j.expneurol.2015.05.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 05/05/2015] [Accepted: 05/08/2015] [Indexed: 01/07/2023]
Abstract
Mild traumatic brain injury (mTBI) affects millions of people annually and is difficult to diagnose. Mild injury is insensitive to conventional imaging techniques and diagnoses are often made using subjective criteria such as self-reported symptoms. Many people who sustain a mTBI develop persistent post-concussive symptoms. Athletes and military personnel are at great risk for repeat injury which can result in second impact syndrome or chronic traumatic encephalopathy. An objective and quantifiable measure, such as a serum biomarker, is needed to aid in mTBI diagnosis, prognosis, return to play/duty assessments, and would further elucidate mTBI pathophysiology. The majority of TBI biomarker research focuses on severe TBI with few studies specific to mild injury. Most studies use a hypothesis-driven approach, screening biofluids for markers known to be associated with TBI pathophysiology. This approach has yielded limited success in identifying markers that can be used clinically, additional candidate biomarkers are needed. Innovative and unbiased methods such as proteomics, microRNA arrays, urinary screens, autoantibody identification and phage display would complement more traditional approaches to aid in the discovery of novel mTBI biomarkers.
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Affiliation(s)
- Jacqueline R Kulbe
- Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, 40536-0509, USA,; Department of Anatomy and Neurobiology, College of Medicine, University of Kentucky, Lexington, KY, 40536-0509, USA
| | - James W Geddes
- Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, 40536-0509, USA,; Department of Anatomy and Neurobiology, College of Medicine, University of Kentucky, Lexington, KY, 40536-0509, USA.
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