TY - JOUR
T1 - Algorithm for symptom attribution and classification following possible mild traumatic brain injury
AU - Pape, Theresa Louise Bender
AU - Herrold, Amy A.
AU - Smith, Bridget
AU - Babcock-Parziale, Judith
AU - Harp, Jordan
AU - Shandera-Ochsner, Anne
AU - Jenkins, Shonna
AU - Evans, Charlesnika T.
AU - Schleenbaker, Randal
AU - High, Walter M.
PY - 2016/11/13
Y1 - 2016/11/13
N2 - Objective: To present a heuristic model of a symptom attribution and classification algorithm (SACA) for mild traumatic brain injury (mTBI). Setting: VA Polytrauma sites. Participants: 422 Veterans. Design: Cross-sectional. Main Measures: SACA, Comprehensive TBI Evaluation (CTBIE), Structured TBI Diagnostic Interview, Minnesota Multiphasic Personality Inventory (MMPI-2-RF), Letter Memory Test, Validity-10. Results: SACA and CTBIE diagnoses differ significantly (P <.01). The CTBIE, compared with SACA, attributes 16% to 500% more symptoms to mTBI, behavioral health (BH), mTBI + BH and symptom resolution. Altering SACA criteria indicate that (1) CTBIE determination of cognitive impairment yields 27% to 110% more mTBI, mTBI + BH and symptom resolution diagnoses, (2) ignoring timing of symptom onset yields 32% to 76% more mTBI, mTBI + BH and Other Condition diagnoses, (3) Proportion of sample having questionably valid profiles using structured TBI diagnostic interview and MMPI-2-RF and Letter Memory Test is 26% whereas with CTBIE item number 23 and Validity-10 is 6% to 26%, (4) MMPI-2-RF F-scale is the only measure identifying Veterans with posttraumatic amnesia for more than 24 hours as having questionably valid profiles. Conclusions: Symptom attribution-based diagnoses differ when using status quo versus the SACA. The MMPI-2-RF F-scale, compared with the Validity-10 and Letter Memory Test, may be more precise in identifying questionably valid profiles for mTBI + BH. The SACA provides a framework to inform clinical practice, resource allocation, and future research.
AB - Objective: To present a heuristic model of a symptom attribution and classification algorithm (SACA) for mild traumatic brain injury (mTBI). Setting: VA Polytrauma sites. Participants: 422 Veterans. Design: Cross-sectional. Main Measures: SACA, Comprehensive TBI Evaluation (CTBIE), Structured TBI Diagnostic Interview, Minnesota Multiphasic Personality Inventory (MMPI-2-RF), Letter Memory Test, Validity-10. Results: SACA and CTBIE diagnoses differ significantly (P <.01). The CTBIE, compared with SACA, attributes 16% to 500% more symptoms to mTBI, behavioral health (BH), mTBI + BH and symptom resolution. Altering SACA criteria indicate that (1) CTBIE determination of cognitive impairment yields 27% to 110% more mTBI, mTBI + BH and symptom resolution diagnoses, (2) ignoring timing of symptom onset yields 32% to 76% more mTBI, mTBI + BH and Other Condition diagnoses, (3) Proportion of sample having questionably valid profiles using structured TBI diagnostic interview and MMPI-2-RF and Letter Memory Test is 26% whereas with CTBIE item number 23 and Validity-10 is 6% to 26%, (4) MMPI-2-RF F-scale is the only measure identifying Veterans with posttraumatic amnesia for more than 24 hours as having questionably valid profiles. Conclusions: Symptom attribution-based diagnoses differ when using status quo versus the SACA. The MMPI-2-RF F-scale, compared with the Validity-10 and Letter Memory Test, may be more precise in identifying questionably valid profiles for mTBI + BH. The SACA provides a framework to inform clinical practice, resource allocation, and future research.
KW - Anxiety
KW - Depression
KW - Diagnostic accuracy
KW - Diagnostic criteria
KW - Mental health conditions
KW - Mild traumatic brain injury
KW - mTBI
KW - Posttraumatic stress disorder
KW - PTSD
KW - Veteran
UR - http://www.scopus.com/inward/record.url?scp=84995679053&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84995679053&partnerID=8YFLogxK
U2 - 10.1097/HTR.0000000000000220
DO - 10.1097/HTR.0000000000000220
M3 - Article
C2 - 26828712
AN - SCOPUS:84995679053
SN - 0885-9701
VL - 31
SP - E10-E22
JO - Journal of Head Trauma Rehabilitation
JF - Journal of Head Trauma Rehabilitation
IS - 6
ER -