Research Reports - Diagnostic accuracy studies in mild traumatic brain injury

PM R. 2013 Oct;5(10):856-81

Pape TL, High WM Jr, St Andre J, Evans C, Smith B, Shandera-Ochsner AL, Wingo J, Moallem I, Baldassarre M, Babcock-Parziale J

OBJECTIVES: To synthesize evidence and report findings from a systematic search
and descriptive analysis of peer-reviewed published evidence of the accuracy of
tests used for diagnosing mild traumatic brain injury (mTBI). The article also
summarizes points of concurrence and divergence regarding case definitions of
mTBI identified during the review. TYPE: Systematic review and descriptive
analysis of published evidence.
LITERATURE SURVEY: A search of PubMed, PsychInfo, and the Cochrane Library for
peer-reviewed publications between 1990 and July 6, 2011, identified 1218
abstracts; 277 articles were identified for full review, and 13 articles met the
criteria for evaluation.
METHODOLOGY: Manuscript inclusion criteria were (1) reported sensitivity (Se) and
specificity (Sp), or reported data were sufficient to compute Se and Sp; (2) >1
participant in the study; (3) at least 80% of the study cohort was ≥18 years of
age; and (4) written in English. Articles describing clinical practice
guidelines, opinions, theories, or clinical protocols were excluded. Seven
investigators independently evaluated each article according to the Standards for
Reporting of Diagnostic Accuracy (STARD) criteria.
SYNTHESIS: Findings indicate that all 13 studies involved civilian noncombat
populations. In 7 studies, authors examined acute mTBI, and in 4 studies,
historical remote mTBI was examined. In the 13 studies, Se ranged from 13%-92%
and Sp ranged from 72%-99%, but confidence in these findings is problematic
because the STARD review indicates opportunities for bias in each study.
CONCLUSIONS: Findings indicate that no well-defined definition or clinical
diagnostic criteria exist for mTBI and that diagnostic accuracy is currently
insufficient for discriminating between mTBI and co-occurring mental health
conditions for acute and historic mTBI. Findings highlight the need for research
examining the diagnostic accuracy for acute and historic mTBI.

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