2011 HSR&D National Meeting Abstract
3020 — Reliability and Validity of the VA TBI Screening Tool
Donnelly KT (VA WNY Healthcare System), Donnelly JP
(University at Buffalo/SUNY), Dunnam M
(Stratton VAMC Albany), Warner G
(Canandaigua VAMC), Kittleson CJ
(Bath VAMC), Constance J
(Syracuse VAMC), Bradshaw C
(Syracuse VAMC), Alt M
(VA WNY Healthcare System)
In 2007, the VA healthcare system began screening all returning war veterans for TBI. The measure implemented had face validity but had not been subjected to psychometric scrutiny. This study provides item analyses, estimates of temporal reliability and internal consistency, and examination of the sensitivity and specificity of the screening instrument.
Five hundred veterans of the wars in Iraq and Afghanistan enrolled in the study, approximately half of whom (248) volunteered. The remaining 252 participants were referred to VA Neuropsychology or Polytrauma clinics.
This psychometric study was completed as part of a larger four-year, multisite prospective cohort study of veterans returning from Iraq and Afghanistan and was completed at five VA medical centers and one VA outpatient clinic in VISN 2. The primary measures included the VA Traumatic Brain Injury Screening Tool (VATBIST), a structured diagnostic interview for TBI, and the PTSD Checklist.
Three hundred twenty (64%) participants screened positive for TBI, with 219 (43.8%) confirmed to have sustained a TBI, based on a structured interview. The screening tool appeared to have high internal consistency (.77) and test-reliability (.80), high sensitivity (.94) and moderate specificity (.59). Diagnostic odds ratios for the screening tool ranged from 12.6 for the total sample to 24, when veterans with probable post traumatic stress disorder were excluded from analysis.
The VATBIST appears to be a reliable and valid screening instrument for veterans. The presence of significant post traumatic stress disorder symptoms, however, reduced the specificity of the measure.
These data highlight the need for careful clinical follow-up of positive screens to include evaluation of PTSD.