Article

OBJECTIVE: To compare the results of Veterans Affairs' (VA's) initial traumatic
brain injury (TBI) Clinical Reminder Screen with the more extensive second-level
Comprehensive TBI Evaluation in a national sample. DESIGN: Criterion-standard.
SETTING: Veterans Health Administration system of polytrauma care. PARTICIPANTS:
The data were from VA's centralized database Patient Care Services on the TBI
Clinical Reminder Screen and Comprehensive TBI Evaluation results of veterans
(N=48,175). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sensitivity, specificity,
positive predictive value, and negative predictive value of the TBI Clinical
Reminder Screen were calculated by using the Comprehensive TBI Evaluation
findings as the comparative standard for TBI confirmation. RESULTS: The TBI
Clinical Reminder Screen has generally good sensitivity (.87-.90) but poor
specificity (.13-.18). In addition, the TBI Clinical Reminder Screen, when
compared with the Comprehensive TBI Evaluation by a clinician, has generally poor
negative predictive power (.31-.49) in this sample. However, negative predictive
power is good with an estimated Veterans Health Administration system-wide TBI
prevalence rate of 15% (.89). Positive predictive power was acceptable (.77) in
this sample. The screen performs comparably across patient demographic and
symptom severity characteristics, as well as across level of polytrauma care.
Systematic evaluations by clinicians primarily reveal mental health-perceived
causes of ongoing symptoms. CONCLUSIONS: In summary, VA's Clinical Reminder
Screen, when evaluated against the follow-up Comprehensive TBI Evaluation, has
good sensitivity but poor specificity.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS