title: Stability and Validity of the Veterans Health Administration's Traumatic Brain Injury Clinical Reminder Screen.
abstract: OBJECTIVE
  Determine the test-retest stability and validity of the Veterans Health Administration's Traumatic Brain Injury Clinical Reminder (VHA-TBI-CR) screen.
  
  
  METHODS
  Criterion-standard.
  
  
  METHODS
  Veterans Health Administration.
  
  
  METHODS
  Ninety-five Operations Enduring Freedom and Iraqi Freedom veterans who had previously completed the VHA-TBI-CR screen were recruited from the Tampa Veterans Affairs Medical Center. Participants were primarily male (89.5%), with a mean age of 41.6 (SD = 11.14) years; 86% completed at least some college and over half were employed (56.8%). The majority of the participants were enlisted (83.2%).
  
  
  METHODS
  Phi coefficients of stability were calculated comparing the original clinically administered VHA-TBI-CR screen, with a paper-and-pencil version of the screen completed as part of the current study. Validity analyses were conducted by comparing the results from both screens to the study's TBI Identification Clinical Interview findings regarding a history of deployment-related traumatic brain injury (TBI). Sensitivity, specificity, positive predictive value, and negative predictive value of the screen were computed. Kappas were also calculated to examine agreement between screens and the study's "criterion standard" TBI diagnosis.
  
  
  METHODS
  None.
  
  
  RESULTS
  The VHA-TBI-CR screen had poor test-retest stability (ϕ = 0.34). The clinically administered VHA-TBI-CR screen had only moderate sensitivity (0.61) but relatively good specificity (0.88). Historical drift was present in the data. Clinical VHA-TBI-CR screens completed within the past 24 months were less accurate (κ = 0.27) than screens completed between 25 and 38 months earlier (κ = 0.63) or those completed between 38 and 57 months earlier (κ = 0.53).
  
  
  CONCLUSIONS
  The VHA-TBI-CR screen has poor test-retest stability and poor validity when compared with a semistructured TBI identification interview. In this sample, sensitivity was unacceptably low such that the screen failed to identify 39% of veterans who were determined to have had a deployment-related TBI.
authors.affiliation: Department of Mental Health and Behavioral Sciences, James A. Haley Veterans Hospital, Tampa, Florida; Departments of Psychology and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida; Defense and Veterans Brain Injury Center, Silver Spring, Maryland; and HSR&D/RR&D Center of Excellence Maximizing Rehabilitation Outcomes, James A. Haley Veterans Hospital, Tampa, Florida).
authors.forename: Rodney D
authors.initials: RD
authors.lastname: Vanderploeg
authors.forename: Heather G
authors.initials: HG
authors.lastname: Belanger
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis* / Q000534:rehabilitation; D004185:Disability Evaluation; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007407:Interviews as Topic; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D017010:Reminder Systems / Q000592:standards*; D012680:Sensitivity and Specificity; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D058014:Veterans Health; D055815:Young Adult