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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1075 — Results of the Comprehensive TBI Evaluation for Veterans Returning from OEF/OIF

Smith BM (Hines COE), Evans CT (Hines COE), Hogan TP (Hines COE), Stroupe KT (Hines COE), St.Andre J (Hines COE), Moll K (Hines COE), Pape T (Hines COE), Saban M (Hines COE), Steiner M (Hines COE)

Objectives:
VA assessment of mild traumatic brain injury (mTBI) includes the mTBI screening clinical reminder followed by a comprehensive TBI evaluation (CTE) for Veterans who have a positive screen. The goals of this study were to describe the results of the mTBI CTE and to examine patient characteristics associated with results of the CTE.

Methods:
This is a retrospective study of 18,872 OEF/OIF Veterans who screened positive for mTBI between April 2007 and FY2008 and subsequently had a CTE as well as complete CTE data. We used national mTBI CR and CTE data obtained from VA's Office of Patient Care Services (PCS) in addition to VA utilization data. Patient characteristics and healthcare utilization were examined using VA Medical SAS datasets. We estimated logistic regression models to examine the association between patient and facility characteristics and having a CTE result indicating symptoms consistent with mTBI.

Results:
48% of Veterans were determined to have symptoms consistent with a mTBI diagnosis. Those who were male (OR = 1.23, 99%CI:1.04-1.46), had PTSD (OR = 1.24, 99%CI:1.12-1.38), or multiple deployments (OR = 1.18,99% CI:1.09-1.28) had higher odds of having a CTE result consistent with symptoms of TBI compared to other Veterans. Characteristics associated with lower odds of having a positive CTE included being African-American compared to white (OR = 0.80, 99%CI:0.71-0.90), older (OR = 0.75,99%CI:0.67–0.85), and longer time since separation (OR = 0.85,99% CI:0.77-0.94). Approximately 91% of Veterans indicated they had problems with pain in the past 30 days, and 30% had pain that interfered moderately or severely with their life. Symptoms reported as severe or very severe included headaches (42%), concentration difficulties (44%), hearing difficulties (29%), difficulty sleeping (61%), and depression (39%).

Implications:
Findings from this study indicate that symptom burden for OEF/OIF Veterans is high regardless of whether or not they had a mTBI. Veterans who are male or had multiple deployments may have higher mTBI rates than other Veterans because of increased blast exposure. Consistent with previous studies, many patients with TBI also have PTSD diagnoses.

Impacts:
Given the large amount of patients that have experienced difficulties with pain, developing pain management strategies and treatment strategies for symptoms such as headaches and sleep problems should be a continuing priority.


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