2011 National Meeting

1038 — Screening for Mild Traumatic Brain Injury in OEF-OIF Deployed Military: An Empirical Assessment of the VHA Experience

Hendricks AM (VA Boston) , Baker E (VA Boston), Charns M (VA Boston), Gardner JA (VA Boston), Iverson KM (VA Boston), Krengel M (VA Boston), Meterko M (VA Boston), Pogoda TK (VA Boston), Stolzmann K (VA Boston), Wolfsfeld L (VA Boston)

Objectives:
The Veterans Health Administration (VHA) screens for traumatic brain injury (TBI) among all its patients who were deployed to Afghanistan or Iraq. This paper reports patient-level results of the screening program in 2008 and 2009 including proportions with confirmed TBI, average VHA utilization, and costs.

Methods:
We studied all screened patients from October 2007 through March 2009 as captured in VHA electronic screening records. The evaluations identified the patients with deployment-related injuries and confirmed TBI. We obtained patient characteristics from Department of Defense and VHA data.

Results:
Of 216,335 VHA patients screened from October 2007 through March 2009, 21% screened positive for a possible TBI (10.5% of women and 22.1% of men). More than half (54%) of all these positive screens had a follow-up evaluation and 57% of those evaluations confirmed a TBI. Thus, of all deployed Veterans screened for TBI in this period, 6.5% had TBI confirmed in a follow-up evaluation; another 0.9% had a prior diagnosis of TBI confirmed in a comprehensive evaluation (for a total of 7.4% with confirmed TBI due to the screening process). If the patients who did not return for comprehensive evaluations are like those who did receive the evaluations (a strong assumption), we would estimate that 14.6% of VHA patients who had been deployed had had a TBI (range 7.3% to 19.3%). Patients with confirmed TBI were more likely to have referrals indicated in the evaluation (82% compared to 64%), but lack of evaluators’ plans for follow-up did not prevent the patients from getting VHA care. In the year after screening, 96% of evaluated patients with referrals received outpatient care, while 90% of those with no referral did so.

Implications:
The VHA TBI screening process is inclusive, providing follow-up evaluation to almost 25% of screened servicemembers. Clinicians refer the majority of those evaluated for further VHA care. Generalizability of the rate of TBI is limited to those who seek VHA healthcare.

Impacts:
VHA’s TBI screening process and coordination of care for patients with positive screens can be improved to ensure patients with possible TBI exposure are referred for appropriate follow-up treatment.