title: Postdeployment traumatic brain injury screening questions: Sensitivity, specificity, and predictive values in returning soldiers.
abstract: OBJECTIVE
  To evaluate the sensitivity, specificity, and predictive values of Post-Deployment Health Assessment traumatic brain injury (TBI) screening questions employed by the Department of Defense (DOD).
  
  
  METHODS
  Complete data was obtained from 3,072 soldiers upon return from a 15-month deployment to Iraq.
  
  
  METHODS
  Comparisons were made between responses to the DOD four-item screener and a brief structured clinical interview for likely deployment-related TBI history. The interview process was facilitated using responses to the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT).
  
  
  RESULTS
  The sensitivity and specificity of the DOD screening tool (positive response to all four items) in comparison to the clinician-confirmed diagnosis was 60% and 96%, respectively. The sensitivity increased to 80%, with a slight decrease in specificity to 93%, for positive TBI screening when affirmative responses to questions 1 and 2 only were included.
  
  
  CONCLUSIONS
  Affirmative responses to questions 1 and 2 of the DOD TBI screening tool demonstrated higher sensitivity for clinician-diagnosed deployment-related TBI. These two items perform better than positive responses to all four questions; the criteria presently being used for documentation and referral of a deployment-related TBI. These findings support further exploration of TBI screening and assessment procedures.
authors.affiliation: Department of Deployment Health, Evans Army Community Hospital, Defense and Veterans Brain Injury Center, Fort Carson, CO, USA. heidi.terrio@amedd.army.mil
authors.forename: Heidi P
authors.initials: HP
authors.lastname: Terrio
authors.forename: Lonnie A
authors.initials: LA
authors.lastname: Nelson
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Betthauser
authors.forename: Jeri E
authors.initials: JE
authors.lastname: Harwood
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Brenner
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000175:diagnosis; D001930:Brain Injuries / Q000175:diagnosis*; D003244:Consciousness Disorders / Q000175:diagnosis; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008889:Military Personnel; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States; D059030:United States Department of Defense; D055815:Young Adult