Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime and the VA Comprehensive TBI Evaluation.
Lauren J Radigan, Regina E McGlinchey, William P Milberg and 1 others
PMID 29194179WHAT IT FOUND
The VA clinical TBI evaluation agreed with the research interview for only 73 of 104 Veterans.
It missed 18 injuries found by the research interview and called 13 Veterans injured when the research interview did not diagnose them.
Key findings
01The clinical VA evaluation agreed with the research interview in 73 of 104 Veterans, and agreement was only fair.
02The clinical evaluation missed 18 Veterans with TBI by the research interview and diagnosed 13 Veterans without TBI by the research interview.
03Using the research interview as the reference, the clinical evaluation identified 76.3% of Veterans with TBI and correctly classified 53.6% of Veterans without TBI.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Both assessments relied on Veterans' memory of injuries that happened months to years earlier, and in some cases combat chaos, blast exposure, or psychological distress could have affected reporting. The clinical evaluations were done at different times relative to the research visit, from 5.27 years before to 3.09 years after. The study excluded five Veterans whose TBI occurred outside deployment, so the comparison applies to deployment-related injuries as handled by the CTBIE. The paper calls the BAT-L a gold standard, but it is still a self-report interview, not an independent biological test. The research interview was done in a research setting and the clinical evaluation was done in VA clinics, so examiner training and setting may have influenced results.
Declared interests
No author conflict declaration is included in the supplied text. The publication types list NIH extramural and U.S. government non-PHS research support.
The easy way to misread this
Do not read the 76.3% detection rate as proof the CTBIE is adequate for TBI diagnosis. In the same sample it correctly classified only 53.6% of Veterans without TBI, and overall agreement with the research interview was fair.