Overdiagnosis of Concussions Among Veterans Leads to Delay in Care for Other Conditions, NEJM Article Says

A focus on concussions, or mild traumatic brain injury, is preventing soldiers returning from battle from being treated for other conditions, according to an article published on Thursday in the New England Journal of Medicine, USA Today reports (Zoroya, USA Today, 4/16). The article was co-authored by Carl Castro, a psychologist at the U.S. Army Medical Research and Materiel Command; Herb Goldberg, a communications specialist at Walter Reed Army Medical Center; and Charles Hoge, director of psychiatry and neuroscience at the Walter Reed Army Institute of Research.

Currently, soldiers returning from the wars in Iraq and Afghanistan undergo a survey in which they are asked if they became dazed and confused following an injury or exposure to a bomb blast in combat. The survey attributes such symptoms to mild TBI, according to the authors. However, the survey often is administered months after the injury was sustained, according to the article (Stobbe, AP/Austin American-Statesman, 4/15). The article states that the survey could cause unnecessary concern among the soldiers and might result in soldiers wrongly attributing certain symptoms to TBI, when they could have been caused by simple causes, such as sleep deprivation. The authors recommend that the current survey be discontinued because most servicemembers who sustain TBI in combat recover within days (USA Today, 4/16). Furthermore, soldiers who are misdiagnosed risk being unnecessarily exposed to drug side effects and other negative conditions, Hoge said (AP/Austin American-Statesman, 4/15).

The article also states that such symptoms often are caused by other conditions, such as depression, post-traumatic stress disorder or substance abuse. The diagnoses for mild TBI could lead to delays in proper treatment of the other conditions, according to the authors. According to USA Today, the article -- the authors of which have conducted some of the earliest influential research on conditions like PTSD for the military -- suggest that the Department of Defense and Department of Veterans Affairs are "relying on flawed science to identify" as many as 360,000 cases of brain injuries sustained by the returning veterans.

Reaction
The article has prompted Army Surgeon General Eric Schoomaker to decide that the TBI survey should be changed, according to a spokesperson for Schoomaker. However, some government and private researchers on TBI disagreed with the article's findings and said that their recommendation could result in some soldiers receiving improper care. John Corrigan, an Ohio State University psychiatrist and researcher who advised VA on the screening process, said it is premature to suggest that most servicemembers who sustain TBI during combat recover within days.

David Hovda, director of the Brain Injury Research Center at the University of California-Los Angeles, said that veterans with mild TBI who do not receive timely treatment could develop long-term neurological problems. Rep Bill Pascrell (D-N.J.), chair of the Congressional Brain Injury Task Force, cautioned against proceeding with "efforts that might restrict the Department of Defense's ability to identify affected individuals and provide them with the proper care and compensation they deserve" (USA Today, 4/16).

The article is available online.