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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3024 — An Evaluation of the VA TBI Screening Clinical Reminder among OEF/OIF Veterans and Active Duty Service Members

Evans CT (CMC3, SCI QUERI, Edward Hines Jr. VA Hospital), Pape T (CMC3, PM&R Edward Hines Jr. VA Hospital), St. Andre JR (CMC3, Edward Hines Jr. VA Hospital), Steiner ML (Edward Hines Jr. VA Hospital, PM&R), Li K (CMC3, Edward Hines Jr. VA Hospital), Miskevics S (CMC3, Edward Hines Jr. VA Hospital), Stroupe KT (CMC3, SCI QUERI, Edward Hines Jr. VA Hospital), Hogan TP (CMC3, SCI QUERI, Edward Hines Jr. VA Hospital), Smith BM (CMC3, SCI QUERI, Edward Hines Jr. VA Hospital)

Objectives:
Traumatic brain injury (TBI) has emerged as the “signature wound” among U.S. troops returning from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). In April 2007, VA implemented a national clinical reminder (CR) to screen for mild TBI (mTBI), but there remains limited information available about the screening tool. The goal of this study was to identify factors associated with screening for mTBI and to describe screening results.

Methods:
Using the national TBI screening health factors database, national OEF/OIF roster, and VA medical inpatient/outpatient SAS datasets, this national retrospective study included 170,715 OEF/OIF Veterans who were eligible for the mTBI screen across VA medical facilities. The reminder elements include four question sets that confirm predisposing events, and immediate, new, and current symptoms. A logistic regression model with a random effect for VA facility examined completion of the screen (p < 0.01 considered significant).

Results:
156,444 (91.6%) Veterans received the mTBI screening. One-fourth of those screened (n = 39,149), had a probable TBI exposure, with blast being the most frequent cause (85.0%). Factors associated with screening included being Hispanic, age 35 or older, having a chronic condition, being within two hours of the nearest VA facility, being service-connected, having post-traumatic stress disorder, a depression diagnosis, and multiple deployments. The highest odds of receiving a screen were seen in those attending community-based outpatient clinics (CBOC) (OR = 2.84, 99% CI 2.14-3.78) vs. Veterans seen in VA medical centers. Screening was lower among those in the Navy (vs. Army) and among those separated from service for more than 6 months. The proportion of variance due to facility was significant (rho = 0.29, p < 0.0001).

Implications:
TBI screening rates are high in VA, with less than 10% of eligible Veterans not being screened. Understanding the differences in patient characteristics and site variability associated with screening outcomes could inform the development of targeted interventions to reach 100% screening completion across all facilities.

Impacts:
In addition to providing an assessment of the mTBI CR, these data indicate that the prevalence of blast injury among OEF/OIF Veterans is high and may impact care. They also suggest areas where mTBI screening can be improved.


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