Risk of Adverse Outcomes Among Veterans Who Screen Positive for Traumatic Brain Injury in the Veterans Health Administration But Do Not Complete a Comprehensive Evaluation: A LIMBIC-CENC Study.
Terri K Pogoda, Rachel Sayko Adams, Kathleen F Carlson and 3 others
PMID 37335204WHAT IT FOUND
Veterans who screened positive for TBI but did not complete the comprehensive evaluation had higher mortality and opioid use disorder risk than those evaluated.
However, those evaluated had higher rates of substance and alcohol use disorders. The un-evaluated group used fewer health services, suggesting missed care opportunities.
Key findings
01Veterans who did not complete the TBI evaluation had a 1.37 times higher risk of mortality compared to those with a confirmed mild TBI diagnosis.
02Those who did not complete the evaluation had a 1.43 times higher risk of opioid use disorder compared to those evaluated and found not to have a TBI.
03Veterans who completed the evaluation, regardless of final TBI status, had a higher risk of substance use disorder and alcohol use disorder than those who did not complete the evaluation.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study relied entirely on Veterans Health Administration (VHA) and Department of Defense (DoD) records, so it missed any care or diagnoses obtained in the private sector or other community settings. It is unclear why patients did not complete the evaluation; the lower utilization in this group could mean they were healthier, or it could mean they were disengaged from care and thus had fewer opportunities for diagnosis. The study did not have specific dates for when the TBI occurred, only when the screening took place, which limits the ability to track the timeline of injury versus outcome. Mortality data did not include cause of death, so the link between the No CTBIE group's higher mortality and potential opioid use is inferred rather than directly proven by autopsy or death certificate details in this analysis.
Declared interests
The research was supported by the U.S. Government (Non-P.H.S.). The text does not list specific commercial conflicts of interest or author disclosures beyond the funding source.
The easy way to misread this
Do not assume the 'No CTBIE' group was healthier simply because they had lower rates of diagnosed substance use disorders. Their higher mortality and opioid use disorder risk, combined with lower healthcare utilization, suggests they may have been disengaged from the system, leading to missed diagnoses and worse outcomes.