SHP 08-167 – HSR&D Study
Career Development Projects
Validation of Brief Objective Neurobehavioral Detectors of Mild TBI
Julie C Chapman
Washington DC VA Medical Center, Washington, DC
April 2008 -
The Veterans Health Administration (VHA) has stated the need for a brief screening instrument that can assist with the triage of the large number of Veterans with mild traumatic brain injury (mTBI) returning from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). The current investigators have combined selected neurologic measures to develop an instrument called, "Brief Objective Neurobehavioral Detectors" (BOND). BOND takes 15-20 minutes to administer and results are immediately available.
A (slight) variation of BOND demonstrated 91% sensitivity to and 76% specificity for subtle brain change in older adults with periventricular white matter abnormalities on magnetic resonance imaging (MRI)1. More recently, we found 70% sensitivity and 69% specificity amongst a group of psychiatric inpatients with diverse diagnoses. In clinical practice, we had observed considerable differences in performance on BOND between veterans with and without mTBI. We proposed a validation study of BOND for use as a screening tool for OEF/OIF veterans with mTBI.
Short-term Objective 1: To determine the criterion-related validity of BOND for predicting an individual's group membership (mTBI or normal).
Short-term Objective 2: To provide evidence for the construct validity of BOND through convergent validity.
Forty-four (44) OEF/OIF veterans were recruited (mTBI=19; non-tbi=25). Each veteran was administered the BOND and selected traditional cognitive tests. Additionally, a subset of the sample underwent diffusion tensor imaging (mTBI=12; non-TBI=16). Association between BOND total score and group membership was assessed. Total BOND score was also correlated with cognitive measures and quantitative metrics from diffusion tensor imaging.
The total BOND score trended with group membership (p=.09). Sensitivity was 63% and specificity was 72% at a cut point of two. BOND total score significantly correlated with nine cognitive measures and two white matter tracts, with all but 1 supporting the hypothesis that BOND is assessing frontal lobe function.
This project represents the secondary hypotheses of a larger study being conducted by the investigative team, the Blast Injury Outcomes (BIO) Study. The BIO study has recently received additional funding. Although recruitment continues, several preliminary impacts have been noted. First, the study evaluation visit provides OEF/OIF veterans with an additional opportunity to ask questions and receive answers about brain injury. Second, the coordination of multidisciplinary staff required for this study has resulted in the collaborative development of several concepts with the potential for positive influences on veteran health. For example, the Principal Investigator and colleagues in Neurology, Research, Radiology, and Occupational Health have designed a clinical neuroimaging algorithm for TBI. The BOND must be validated in a larger group of demographically-matched Veterans with different mechanisms of TBI. This further validation will take place as the BIO Study continues and also in the MIND Study.
None at this time.
Military and Environmental Exposures
Deployment Related, Operation Iraqi Freedom, Traumatic Brain Injury