Journal of Rehabilitation Research & Development (JRRD)

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Volume 51 Number 3, 2014
   Pages 363 — 376

Abstract — Concordance of clinician judgment of mild traumatic brain injury history with a diagnostic standard

Terri K. Pogoda, PhD;1–2* Katherine M. Iverson, PhD;3 Mark Meterko, PhD;1–2 Errol Baker, PhD;1 Ann M. Hendricks, PhD;2,4 Kelly L. Stolzmann, MS;1 Maxine Krengel, PhD;5 Martin P. Charns, DBA;1–2 Jomana Amara, PhD;6 Rachel Kimerling, PhD;7 Henry L. Lew, MD, PhD8

1Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs (VA) Boston Healthcare System, Boston, MA; 2Department of Health Policy and Management, Boston University School of Public Health, Boston, MA; 3National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA; and Department of Psychiatry, Boston University School of Medicine, Boston, MA; 4Health Care Financing and Economics, VA Boston Healthcare System, Boston, MA; 5Research and Development Service, VA Boston Healthcare System, Boston, MA; and Department of Neurology, Boston University School of Medicine, Boston, MA; 6Defense Resource Management Institute, Naval Postgraduate School, Monterey, CA; 7National Center for Posttraumatic Stress Disorder and Center for Health Care Evaluation, VA Palo Alto Healthcare System, Palo Alto, CA; 8Department of Physical Medicine and Rehabilitation, Defense and Veterans Brain Injury Center, Virginia Commonwealth University, Richmond, VA; and Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawai’i at Mānoa, Honolulu, HI

Abstract — The concordance of Department of Veterans Affairs (VA) clinician judgment of mild traumatic brain injury (mTBI) history with American Congress of Rehabilitation Medicine (ACRM)-based criteria was examined for Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans. In order to understand inconsistencies in agreement, we also examined the associations between evaluation outcomes and conceptually relevant patient characteristics, deployment-related events, current self-reported health symptoms, and suspected psychiatric conditions. The Veteran sample comprised 14,026 OIF/OEF VA patients with deployment-related mTBI history (n = 9,858) or no history of mTBI (n = 4,168) as defined by ACRM-based criteria. In the majority of cases (76.0%), clinician judgment was in agreement with the ACRM-based criteria. The most common inconsistency was between clinician judgment (no) and ACRM-based criteria (yes) for 21.3% of the patients. Injury etiology, current self-reported health symptoms, and suspected psychiatric conditions were additional factors associated with clinician diagnosis and ACRM-based criteria disagreement. Adherence to established diagnostic guidelines is essential for accurate determination of mTBI history and for understanding the extent to which mTBI symptoms resolve or persist over time in OIF/OEF Veterans.

Key words: American Congress of Rehabilitation Medicine guidelines, blast injuries, comprehensive traumatic brain injury evaluation, diagnosis, mild traumatic brain injury, neurobehavioral manifestations, non-blast injuries, posttraumatic stress disorder, psychological factors, Veterans.


View HTML ¦ View PDF ¦ Contents Vol. 51, No.3
This article and any supplementary material should be cited as follows:
Pogoda TK, Iverson KM, Meterko M, Baker E, Hendricks AM, Stolzmann KL, Krengel M, Charns MP, Amara J, Kimerling R, Lew HL. Concordance of clinician judgment of mild traumatic brain injury history with a diagnostic standard. J Rehabil Res Dev. 2014;51(3): 363–76.
http://dx.doi.org/10.1682/JRRD.2013.05.0115
ResearcherID/ORCID: Terri K. Pogoda, PhD: F-6243-2012
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