Abstract
Objective: Determine the test-retest stability and validity of the Veterans Health Administration's Traumatic Brain Injury Clinical Reminder (VHA-TBI-CR) screen.
Design: Criterion-standard.
Setting: Veterans Health Administration.
Participants: Ninety-five Operations Enduring Freedom and Iraqi Freedom veterans who had previously completed the VHA-TBI-CR screen were recruited from the Tampa Veterans Affairs Medical Center. Participants were primarily male (89.5%), with a mean age of 41.6 (SD = 11.14) years; 86% completed at least some college and over half were employed (56.8%). The majority of the participants were enlisted (83.2%).
Main Outcome Measures: Phi coefficients of stability were calculated comparing the original clinically administered VHA-TBI-CR screen, with a paper-and-pencil version of the screen completed as part of the current study. Validity analyses were conducted by comparing the results from both screens to the study's TBI Identification Clinical Interview findings regarding a history of deployment-related traumatic brain injury (TBI). Sensitivity, specificity, positive predictive value, and negative predictive value of the screen were computed. Kappas were also calculated to examine agreement between screens and the study's "criterion standard" TBI diagnosis.
Interventions: None.
Results: The VHA-TBI-CR screen had poor test-retest stability ([script phi] = 0.34). The clinically administered VHA-TBI-CR screen had only moderate sensitivity (0.61) but relatively good specificity (0.88). Historical drift was present in the data. Clinical VHA-TBI-CR screens completed within the past 24 months were less accurate ([kappa] = 0.27) than screens completed between 25 and 38 months earlier ([kappa] = 0.63) or those completed between 38 and 57 months earlier ([kappa] = 0.53).
Conclusion: The VHA-TBI-CR screen has poor test-retest stability and poor validity when compared with a semistructured TBI identification interview. In this sample, sensitivity was unacceptably low such that the screen failed to identify 39% of veterans who were determined to have had a deployment-related TBI.