title: Screening for Remote History of Mild Traumatic Brain Injury in VHA: A Critical Literature Review.
abstract: The authors reviewed the existing literature on the Veterans Health Administration's (VHA's) traumatic brain injury (TBI) screening and evaluation program to provide a qualitative synthesis and critical review of results focusing on the psychometric properties of the screen.
  
  
  
  All studies of the VHA's screening and evaluation process were reviewed, both those involving primary data collection and those relying upon VHA data. Diagnostic statistics were summarized and also recalculated on the basis of a positive screening rate of 20%, the observed rate within the VHA, and an estimated population prevalence of TBI of 15% within the Department of Veterans Affairs (VHA).
  
  
  
  The TBI screen within the VHA is administered to nearly every eligible patient. The majority of clinical presentations are deemed to be due to mental health and/or a combination of mental health and TBI factors. The screen has good internal consistency, variable test-retest reliability, and questionable validity, with poor agreement between the TBI screen and criterion standards overall. Studies based on nonrepresentative samples reported high sensitivity. Assuming the VHA's TBI screening rate of 20% in a hypothetical sample, sensitivity is poor (the screen misses 30%-60% of TBI cases). However, specificity remains adequate. Studies based on samples with high rates of TBI reported much higher positive predictive values (and slightly lower negative predictive values) than those observed when a hypothetical TBI prevalence of 15% was used.
  
  
  
  Questions remain about the validity of the TBI screen. Future research should address the utility of screening for TBI.
authors.affiliation: Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, Florida (Drs Belanger and Vanderploeg); Departments of Psychology and Psychiatry, University of South Florida, Tampa (Drs Belanger and Vanderploeg); Defense and Veterans Brain Injury Center, Tampa, Florida (Drs Belanger and Vanderploeg); Tampa HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research (CIDRR8), Tampa, Florida (Drs Belanger and Vanderploeg); Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota (Dr Sayer); and Departments of Medicine and Psychiatry, University of Minnesota, Minneapolis (Dr Sayer).
authors.forename: Heather G
authors.initials: HG
authors.lastname: Belanger
authors.forename: Rodney D
authors.initials: RD
authors.lastname: Vanderploeg
authors.forename: Nina
authors.initials: N
authors.lastname: Sayer
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D054542:Iraq War, 2003-2011; D008403:Mass Screening; D009483:Neuropsychological Tests / Q000592:standards*; D011594:Psychometrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*