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. Setting 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. Participants Community-dwelling convenience sample of 179 OEF/OIF/OND veterans. Main measures 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.

A methodology for assessing deployment trauma and its consequences in OEF/OIF/OND veterans: The TRACTS longitudinal prospective cohort study

“…These data suggest that there should be an integrated screening process for mTBI and PTSD, given their high rate of co‐occurrance and shared symptoms. As we have demonstrated (Fortier, Amick, Kenna, Milberg, & McGlinchey, ), separate screenings for each, even if both are eventually completed, may lead to misdiagnoses and inappropriate treatments.…”

Sleep Quality and Reexperiencing Symptoms of PTSD Are Associated With Current Pain in U.S. OEF/OIF/OND Veterans With and Without mTBIs

“…We had a high degree of confidence in this finding, as the study employed a sophisticated method to diagnose TBI that, while still relying on self-report, was a clinician-administered diagnostic tool that has proven validity and reliability (Fortier et al, 2014). Our Fortier et al, 2015), and false-negatives (ß15%; Fortier et al, 2015) up to a 40% rate (Lang et al, 2014). Similarly, studies assessing veterans' pain have focused on TBIs sustained during deployment, failing to systematically assess TBIs acquired throughout the life span.…”

Reduced cortical thickness in veterans exposed to early life trauma

“…TBI exposure was assessed using the Boston Assessment of TBI-Lifetime (BAT-L) (Fortier et al, 2013; Fortier et al, in press), a measure developed at the TRACTS CoE, based on the diagnostic criteria of the Department of Defense, to capture the unique injuries sustained during OEF/OIF deployment (as well as injuries incurred during civilian experiences) with great detail, including the context and events occurring before, during, and after the injury. The diagnostic criteria encompass Mild, Moderate and Severe, depending on the duration of loss of consciousness, post-traumatic amnesia and altered state of consciousness.…”