Screening for mild traumatic brain injury in the presence of psychiatric comorbidities.
OBJECTIVE
To determine whether or not a battery of neurobehavioral tests, the Brief Objective Neurobehavioral Detector (BOND), could detect mild traumatic brain injury (mTBI) among a group of psychiatric inpatients with numerous substance-related and medical comorbidities. The 16-item BOND is comprised of neurologic examination tasks and has been shown to correlate with radiologic and cognitive findings in previous studies.


METHODS
Masked comparison.


METHODS
Inpatient psychiatric unit at the Veterans Affairs Medical Center in Washington, DC.


METHODS
Patients (N=51) sequentially admitted for suicidal ideation in the context of various psychiatric disorders.


METHODS
No intervention.


METHODS
BOND total and subtest scores.


RESULTS
Forty-three patients were eligible and analyzed. Twenty-seven had sustained an mTBI in the distant past, and 16 had never sustained a traumatic brain injury (TBI) (non-TBI group). On average, the mTBI group demonstrated a significantly greater number of abnormal subtests on the BOND (mean, 7.22) than did the non-TBI group (mean, 4.50; P=.003). Although the BOND significantly correlated with the presence of mTBI, it did not correlate with any of the psychiatric, substance-related, or medical comorbidities. Multiple regressions indicated that the BOND total score was not explained by age, posttraumatic stress disorder diagnosis, or any combination of the psychiatric, substance-related, or medical comorbidities. High rates of sensitivity (70%) and specificity (69%) were found.


CONCLUSIONS
The results of this pilot study suggest that the inexpensive, brief, and objective BOND instrument may be a useful screening tool for the detection of subtle neurologic brain abnormalities after mTBI, even in the presence of substantial comorbidities.
Chapman
Julie C
JC
War Related Illness and Injury Study Center, Veterans Affairs Medical Center, Washington, DC, USA. Julie.Chapman@va.gov
Andersen
Allan M
AM
Roselli
Lauren A
LA
Meyers
Noah M
NM
Pincus
Jonathan H
JH
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D009483:Neuropsychological Tests; D015588:Observer Variation; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices