Analysis of US Veterans Health Administration comprehensive evaluations for traumatic brain injury in Operation Enduring Freedom and Operation Iraqi Freedom Veterans

Joel D. Scholten, Nina A. Sayer, Rodney D. Vanderploeg, Douglas E. Bidelspach, David X. Cifu

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


Objective: To describe neurobehavioural symptoms in Iraq and Afghanistan war veterans evaluated for traumatic brain injury (TBI) through the Veterans Health Administration (VHA) TBI screening and evaluation programme. Design: An observational study based on VHA administrative data for all veterans who underwent TBI Comprehensive Evaluation between October 2007 and June 2010. Results: 55,070 predominantly white, non-Hispanic, male Veterans with a positive TBI screen had comprehensive TBI evaluations completed during the study period. Moderate-to-severe symptoms were common in the entire sample, both in those with and without a clinician-diagnosed TBI. However, the odds of reporting symptoms of this severity were significantly higher in those diagnosed with TBI compared to those without a TBI diagnosis, with odds ratios ranging from 1.352.21. TBI-specialty clinicians believed that in the majority of diagnosed TBI cases both behavioural health conditions and TBI contributed to patients' symptom presentation. Conclusions: The VHAs TBI screening and evaluation process is identifying individuals with ongoing neurobehavioural symptoms. Moderate-to-severe symptoms were more prevalent in veterans with TBI-specialty clinician determined TBI. However, the high rate of symptom reporting also present in individuals without a confirmed TBI suggest that symptom aetiology may be multi-factorial in nature.

Original languageEnglish (US)
Pages (from-to)1177-1184
Number of pages8
JournalBrain Injury
Issue number10
StatePublished - Sep 2012

Bibliographical note

Funding Information:
conflicts of interest. This research was performed at the Minneapolis VA Healthcare System, Minneapolis, MN. This manuscript 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 Service (HSR&D) Quality Enhancement Research Initiative (QUERI) Locally Initiated Project (QUERI LIP PLY 10-4218). The content of this report presents the findings and conclusions of the authors and does not necessarily represent the VA or HSR&D. The VA had no role in study design, analysis and interpretation of data; writing of the article; or the decision to submit it for publication.


  • Health services needs and demand
  • Traumatic brain injury
  • United States Department of Veterans Affairs


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