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Evaluation of the Veterans Health Administration Traumatic Brain Injury Screening Program in the Upper Midwest

Sayer, Nina A. PhD; Nelson, Dave PhD; Nugent, Sean BA

The Journal of Head Trauma Rehabilitation: November/December 2011 - Volume 26 - Issue 6 - p 454–467
doi: 10.1097/HTR.0b013e3181ff393c
Original Articles

Objective: To evaluate the Veterans Health Administration's traumatic brain injury (TBI) screening program in terms of predictors of screening and positive-screen follow-up.

Design: Retrospective administrative data study. Multiple logistic regression analyses were used to estimate the odds of TBI screening at a given appointment and among those screening positive, follow-up in a TBI/polytrauma specialty clinic.

Participants: A total of 15 973 Iraq and Afghanistan war veterans treated at a Veterans Affairs medical center in the upper Midwest during the first 18 months of the TBI screening program.

Results: Almost 90% of Iraq and Afghanistan veteran patients were offered TBI screening and 17% screened positive. Screening rates increased over time and varied by facility. Appointment type predicted screening with increased likelihood of screening during primary care and TBI/polytrauma clinic appointments. Younger, male, and army veterans without psychiatric diagnoses were more likely to be screened. Fifty-two percent of positive TBI screens had subsequent appointments in a TBI/polytrauma specialty clinic during the study period. Rates of follow-up in the clinic increased over time and varied by facility and patient characteristics.

Conclusions: Within the upper Midwest, Veterans Health Administration has had greater success implementing TBI screening than ensuring follow-up of positive screens in a specialty clinic. Research is needed on barriers to follow-up of positive screens and the outcomes of TBI screening and subsequent specialty care.

Center for Chronic Diseases Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota (Drs Sayer and Nelson and Mr Nugent); and Department of Medicine (Drs Sayer and Nelson) and Psychiatry (Dr Sayer), University of Minnesota.

Corresponding Author: Nina A. Sayer, PhD, VA Medical Center, Center for Chronic Disease Outcomes Research, 152/2E, One Veterans Dr, Minneapolis, MN 55417 (

This article represents original and valid research that has not been previously published and is not under consideration for publication elsewhere. This research was supported by a Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Quality Enhancement Research Initiative (QUERI) locally initiated project (QUERI LIP PLY 05-403-5). The content of this article presents the findings and conclusions of the authors and does not necessarily represent the VA or HSR&D. Portions of these data were presented at the VA HSR&D, 2008, QUERI national meeting in Phoenix, Arizona.

The authors declare no conflicts of interest.

© 2011 Lippincott Williams & Wilkins, Inc.