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MISDIAGNOSIS OF TRAUMATIC BRAIN INJURY WORRIES
HEALTHCARE WORKERS AND VETERANS' ADVOCATES --
TBI is being diagnosed as depression, PTSD and
other
mental health issues putting veterans'
healthcare at risk.
Story here...
http://www.boston.com/
news/nation/articles/2007/06/10/con
cerns_grow_about_war_
veterans_misdiagnoses/
Story below:
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Concerns grow about war veterans' misdiagnoses
Brain injuries can defy easy detection
By Laura M. Colarusso, Globe Correspondent
As the medical community learns more about the brain impairments
afflicting troops fighting in Iraq and Afghanistan, concern is growing
back home that these battle-weary soldiers may be facing yet another
obstacle: misdiagnosis.
Traumatic brain injury has become a high-profile condition, thrust into
the national spotlight now that thousands of troops who have left the
war zone continue to struggle with the consequences of combat. Better
known as TBI, the ailment is a physical wound caused by the
head-rattling shockwaves associated with bomb explosions that tear brain
cells apart.
But TBI shares many of the same symptoms with a common battlefield
psychological condition known as post-traumatic stress disorder. Both
are often marked by depression, mood swings, irritability, problems
concentrating, and memory dysfunction. The similarities can cause
healthcare professionals to overlook mild traumatic brain injuries,
especially when a patient lacks visible wounds, according to doctors and
veterans advocates familiar with the issue.
"Mild brain injuries are really difficult to evaluate because there are
a lot of overlapping symptoms with post-traumatic stress disorders,"
said Jordan Grafman, a neuroscientist who studies the effects of TBI on
Vietnam veterans at the National Institutes of Health. "Doctors are
likely to default to psychological diagnoses especially when they see a
lot of PTSD."
Officials at the Pentagon and the Department of Veterans Affairs say
that misdiagnosing mild TBI as PTSD is especially problematic because
the two conditions are treated differently. Stress disorders are usually
treated with counseling and anti anxiety or anti depression medications,
while brain injuries typically require some combination of occupational,
physical, and cognitive therapy.
"The difficulty in sorting the two out is there are common features
[between] them," said Dr. Steven Scott, director of the VA's Tampa
Polytrauma Rehabilitation Center . "If you have a better idea what's
wrong with the individual and make a diagnosis, you will have better
outcomes."
The earlier treatment begins, the better the results, Scott said.
When left unchecked, TBI can disrupt the basic functions of everyday
life, making it difficult to perform even simple tasks like getting
ready for work or grocery shopping. Most TBIs affect the frontal lobes,
which account for about 40 percent of the brain and control a person's
ability to structure their day-to-day living.
One of the challenges in diagnosing TBI is that mild brain damage is
difficult to find, particularly since it can take months for the initial
symptoms to manifest, Scott said. Patients with both a psychological
disorder and mild brain injury present an even bigger challenge because
in these cases, the brain damage may be masked and therefore go
undetected, he added.
The same is true in the civilian world, said Dr. Gregory O'Shanick,
national medical director for the Brain Injury Association of America.
Though there are some differences in TBI and PTSD symptoms, brain injury
cases continue to slip through the cracks because the signs are easy to
miss, he said.
"Misdiagnosis happens all of the time," said O'Shanick, who has seen
dozens of TBI patients originally diagnosed with depression.
"You see somebody in the military when their lives are organized for
them, you may not notice mild traumatic brain injury in [its] fullest
form when they're on active duty," O'Shanick said. "But when they come
back home and their external structure isn't there, that's where you may
see things become much more evident in terms of traumatic brain injury."
Exactly how many TBI cases there are among Iraq and Afghanistan veterans
is unknown because neither the Pentagon nor the Department of Veterans
Affairs has systematically screened returning troops for the disorder.
The lack of a comprehensive plan to deal with brain injuries has
provoked harsh criticism from lawmakers and veterans advocates, who
accuse the government of neglecting the troops they sent into battle.
With troops deploying for their second, third, even fourth tours of
duty, head injuries and stress disorders are becoming more widespread,
said Representative Bob Filner, Democrat of California, chairman of the
House Veterans Affairs Committee. For every year in the war zone, combat
units encounter dozens of potentially brain-injuring blasts, each one
doing more harm because the damage is cumulative.
"We don't have the resources in place, and they're scrambling now [to
deal] with something that could have been predicted and planned for,"
Filner said. "TBI is one of the major things coming out of the war we
haven't taken care of, and it's going to have long-range effects on our
society for years to come."
The psychological wounds associated with combat are well documented.
However, little is known about how explosions affect the brain, and the
military has been slow to address soldiers' medical needs, often leaving
ailing troops and their families to sort out the symptoms, Filner said.
Statistics compiled by the VA show that more than 83,000 Iraq and
Afghanistan veterans have sought care for psychological disorders. The
department does not track the number of TBI cases, according to
spokesman Terry Jemison, who noted that they do know of at least 369
traumatic brain injury patients because they've been treated for other
acute conditions.
The Defense Department also does not have figures on the number of brain
injuries, but Pentagon officials estimated that they have found about
2,500 potential cases so far.
The government's inability to track TBI cases has angered many veterans
advocates who say the lack of attention is another example of how the
military failed to prepare for the troops who are now coming home
injured. Critics point to long waits for appointments and the squalid
conditions at Walter Reed Army Medical Center.
"The number of people who have suffered from mild traumatic brain injury
could be in the thousands, but we just won't know about it unless we
screen everybody who comes back," said Paul Rieckhoff, executive
director of Iraq and Afghanistan Veterans of America. "The system as it
stands right now really depends on [veterans] to self-diagnose and then
navigate the bureaucracy of red tape to get help."
Diagnosing brain injuries requires thorough clinical evaluation that
includes memory and response-time tests. Whether the VA and the Pentagon
have the resources to do this for the millions of veterans who have
deployed remains to be seen, Rieckhoff said.
"Maybe it's politics, maybe it's negligence, maybe it's incompetence,"
Rieckhoff said. "I don't know. I just know that it's taking too long to
take things like brain injury seriously."
Scott and others at the VA believe the department will start finding
more cases because of a four-question screening tool that was put into
place in April. Every veteran who visits a VA facility for treatment
will be asked whether they've been near a blast, and if so, whether they
experienced any difficulties afterward .
This month, the Pentagon expects to add similar questions to its
post-deployment health questionnaire, which is given to all troops
returning from the war zone.
However, the lag in adopting a screening tool has prompted Senator Susan
Collins, Republican of Maine, and Senator Hillary Clinton, Democrat of
New York, to propose a computer-based test that would assess an
individual's cognitive functioning before and after deployment. Their
legislation would provide $3.75 million to institute the program.
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Larry Scott --
