title: Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) clinical interview and the VA TBI screen.
abstract: OBJECTIVE
  Mild traumatic brain injury is the signature injury of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND), yet its identification and diagnosis is controversial and fraught with challenges.
  
  
  METHODS
  In 2007, the Department of Veterans Affairs (VA) implemented a policy requiring traumatic brain injury (TBI) screening on all individuals returning from deployment in the OEF/OIF/OND theaters of operation that lead to the rapid and widespread use of the VA TBI screen. The Boston Assessment of TBI-Lifetime (BAT-L) is the first validated, postcombat semistructured clinical interview to characterize head injuries and diagnose TBIs throughout the life span, including prior to, during, and post-military service.
  
  
  METHODS
  Community-dwelling convenience sample of 179 OEF/OIF/OND veterans.
  
  
  METHODS
  BAT-L, VA TBI screen.
  
  
  RESULTS
  Based on BAT-L diagnosis of military TBI, the VA TBI screen demonstrated similar sensitivity (0.85) and specificity (0.82) when administered by research staff. When BAT-L diagnosis was compared with historical clinician-administered VA TBI screen in a subset of participants, sensitivity was reduced.
  
  
  CONCLUSIONS
  The specificity of the research-administered VA TBI screen was more than adequate. The sensitivity of the VA TBI screen, although relatively high, suggests that it does not oversample or "catch all" possible military TBIs. Traumatic brain injuries identified by the BAT-L, but not identified by the VA TBI screen, were predominantly noncombat military injuries. There is potential concern regarding the validity and reliability of the clinician administered VA TBI screen, as we found poor correspondence between it and the BAT-L, as well as low interrater reliability between the clinician-administered and research-administered screen.
authors: Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, Massachusetts (Drs Fortier, Amick, Kenna, Milberg, and McGlinchey); Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts (Drs Fortier, Milberg, and McGlinchey); Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (Drs Fortier, Milberg, and McGlinchey); and Department of Psychiatry, Boston University Medical School, Boston, Massachusetts (Dr Amick).
authors: Catherine Brawn
authors: CB
authors: Fortier
authors: Melissa M
authors: MM
authors: Amick
authors: Alexandra
authors: A
authors: Kenna
authors: William P
authors: WP
authors: Milberg
authors: Regina E
authors: RE
authors: McGlinchey
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001930:Brain Injuries / Q000175:diagnosis*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012680:Sensitivity and Specificity; D014728:Veterans; D055815:Young Adult