title: Concordance of clinician judgment of mild traumatic brain injury history with a diagnostic standard.
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.
authors.affiliation: VA Boston Healthcare System, 150 S Huntington Ave (152M), Boston, MA 02130. terri.pogoda@va.gov.
authors.forename: Terri K
authors.initials: TK
authors.lastname: Pogoda
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Iverson
authors.forename: Mark
authors.initials: M
authors.lastname: Meterko
authors.forename: Errol
authors.initials: E
authors.lastname: Baker
authors.forename: Ann M
authors.initials: AM
authors.lastname: Hendricks
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stolzmann
authors.forename: Maxine
authors.initials: M
authors.lastname: Krengel
authors.forename: Martin P
authors.initials: MP
authors.lastname: Charns
authors.forename: Jomana
authors.initials: J
authors.lastname: Amara
authors.forename: Rachel
authors.initials: R
authors.lastname: Kimerling
authors.forename: Henry L
authors.initials: HL
authors.lastname: Lew
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000647:Amnesia / Q000209:etiology; D001007:Anxiety / Q000209:etiology; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology*; D003244:Consciousness Disorders / Q000209:etiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D005260:Female; D006304:Health Status; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008487:Medical History Taking; D001523:Mental Disorders / Q000209:etiology*; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology; D014481:United States; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: American Congress of Rehabilitation Medicine 
  guidelines; Veterans; blast injuries; comprehensive traumatic brain injury 
  evaluation; diagnosis; mild traumatic brain injury; neurobehavioral manifestations; non-blast injuries; posttraumatic stress 
  disorder; psychological factors