title: Assessing for mild TBI among Iraq and Afghanistan veterans: Outcomes of injury severity and neurological factors.
abstract: OBJECTIVE
  To investigate injury severity markers and neurological symptoms associated with clinician-confirmed mild traumatic brain injury (TBI) among Iraq and Afghanistan veterans.
  
  
  METHODS
  Department of Veterans Affairs (VA) medical centre and five affiliated community-based outpatient clinics.
  
  
  METHODS
  Three hundred and fifty Iraq and Afghanistan veterans with positive initial VA TBI screens between 1 April 2007 and 1 June 2010 and clinician-confirmed TBI status by 1 December 2010.
  
  
  METHODS
  Retrospective-cohort study of medical record data. Main measures included clinician-confirmed TBI status, injury severity markers (e.g. loss of consciousness (LOC), post-traumatic amnesia (PTA) or confusion/disorientation) and neurological symptoms.
  
  
  RESULTS
  Among veterans who screened positive on the initial VA TBI and then received a clinician evaluation, 60% were confirmed to have a TBI diagnosis. Veterans reporting at least one LOC, confusion or PTA were almost 18-times more likely to receive a confirmed TBI diagnosis. Odds of clinician-confirmed TBI were 2.5-3-times greater among those who endorsed dizziness, poor coordination, headaches, nausea, vision problems and/or irritability, compared to those not endorsing these symptoms. Nausea had greatest utility for confirming a TBI.
  
  
  CONCLUSIONS
  Identification of neurologic symptoms that most contribute to a clinician-confirmed diagnosis of TBI has potential for streamlining detection of TBI and symptoms needed for treatment.
authors.affiliation: a San Francisco VA Medical Center , San Francisco , CA , USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Lau
authors.affiliation: a San Francisco VA Medical Center , San Francisco , CA , USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Madden
authors.affiliation: a San Francisco VA Medical Center , San Francisco , CA , USA.|b Department of Psychiatry.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.affiliation: a San Francisco VA Medical Center , San Francisco , CA , USA.|b Department of Psychiatry.|c Department of Medicine , University of California, San Francisco , San Francisco , CA , USA.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
authors.affiliation: a San Francisco VA Medical Center , San Francisco , CA , USA.|b Department of Psychiatry.
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001924:Brain Concussion / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012189:Retrospective Studies; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Traumatic brain injury; injury severity markers; nausea; neurologic symptoms; veterans