Analysis of US Veterans Health Administration comprehensive evaluations for traumatic brain injury in Operation Enduring Freedom and Operation Iraqi Freedom Veterans.
OBJECTIVE
To describe neurobehavioural symptoms in Iraq and Afghanistan war veterans evaluated for traumatic brain injury (TBI) through the Veterans Health Administration (VHA) TBI screening and evaluation programme.


METHODS
An observational study based on VHA administrative data for all veterans who underwent TBI Comprehensive Evaluation between October 2007 and June 2010.


RESULTS
55,070 predominantly white, non-Hispanic, male Veterans with a positive TBI screen had comprehensive TBI evaluations completed during the study period. Moderate-to-severe symptoms were common in the entire sample, both in those with and without a clinician-diagnosed TBI. However, the odds of reporting symptoms of this severity were significantly higher in those diagnosed with TBI compared to those without a TBI diagnosis, with odds ratios ranging from 1.35-2.21. TBI-specialty clinicians believed that in the majority of diagnosed TBI cases both behavioural health conditions and TBI contributed to patients' symptom presentation.


CONCLUSIONS
The VHAs TBI screening and evaluation process is identifying individuals with ongoing neurobehavioural symptoms. Moderate-to-severe symptoms were more prevalent in veterans with TBI-specialty clinician determined TBI. However, the high rate of symptom reporting also present in individuals without a confirmed TBI suggest that symptom aetiology may be multi-factorial in nature.
Physical Medicine and Rehabilitation Program Office, Department of Veterans Affairs , Washington, DC 20422, USA. joel.scholten@va.gov
Joel D
JD
Scholten
Nina A
NA
Sayer
Rodney D
RD
Vanderploeg
Douglas E
DE
Bidelspach
David X
DX
Cifu
D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008875:Middle Aged; D020380:Needs Assessment; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D055815:Young Adult