Excerpt

United States (U.S.) Veterans Affairs (VA) and Department of Defense (DoD) healthcare facilities are increasingly serving a large population of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans who have sustained traumatic brain injury (TBI), suffer from post-traumatic stress disorder (PTSD), or have both a history of TBI and current PTSD (TBI/PTSD). Mild TBI (mTBI) is considered the most common form of TBI. Uncertainty exists regarding the long-term health outcomes of mTBI as well as the validity of criteria used to assess for a history of this injury. Symptoms that may be attributable to mTBI are similar to symptoms of PTSD. It is unknown whether findings from civilian populations with both a history of mTBI and PTSD (mTBI/PTSD) are applicable to individuals with combat-related mTBI/PTSD. Current evidence-based practices to screen, diagnose, prospectively evaluate, and treat mTBI symptoms or PTSD may be less accurate or effective if and when these conditions co-occur. Thus, there is a need to develop an evidence base to identify best practices to define, diagnose, evaluate, and manage patients with mTBI/PTSD, particularly in U.S. veterans of OEF/OIF.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • RESULTS
  • FUTURE RESEARCH NEEDS
  • CONCLUSIONS
• INTRODUCTION
  • BACKGROUND
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESMENT
  • DATA SYNTHESIS
  • ACTIVE RESEARCH
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • Key Question #1. What is the observed prevalence of comorbid TBI and PTSD? Does the reported prevalence vary by study population, trauma etiology, TBI severity, or methods of case ascertainment?
  • Key Question #2. 2a. What is known about the relative accuracy of diagnostic tests used for assessing mild TBI when comorbid with PTSD? 2b. What is known about the relative accuracy of diagnostic tests used for assessing PTSD when comorbid with mild TBI?
  • Key Question #3. 3a. Are there psychosocial or pharmacological therapies used for treatment of mTBI and PTSD simultaneously? 3b. Are therapies for treatment of mTBI effective when mTBI is comorbid with PTSD? Is there evidence of harms? 3c. Are therapies for treatment of PTSD effective when PTSD is comorbid with mTBI? Is there evidence of harms?
  • Literature Review KQ 1–3 - Limitations
  • ACTIVE RESEARCH
  • ACTIVE RESEARCH - LIMITATIONS
• SUMMARY AND DISCUSSION
  • CONCLUSIONS
  • FUTURE RESEARCH RECOMENDATIONS
• REFERENCE LIST
• Appendix A SEARCH STRATEGY
• Appendix B DATA ABSTRACTION FORM
• Appendix C PEER REVIEWER COMMENTS
• Appendix D EVIDENCE TABLES
• Appendix E ACTIVE RESEARCH FINDINGS

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Minneapolis Veterans Affairs Medical Center, Minnesota Evidence Synthesis Program, Center for Chronic Disease Outcomes Research, Minneapolis, MN.

This report is based on research conducted by the Minneapolis Veterans Affairs Medical Center, Minnesota Evidence Synthesis Program, and the Center for Chronic Disease Outcomes Reasearch under contract to the Department of Veterans Affairs. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs.

This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. The Department of Veterans Affairs endorsement of such derivative products may not be stated or implied.