3 Question DVBIC TBI Screening Tool
1. Did you have any injury(ies) during your deployment from any of the following? (check all that apply):
A. Fragment
B. Bullet
C. Vehicular (any type of vehicle, including airplane)
D. Fall
E. Blast (Improvised Explosive Device, RPG, Land mine, Grenade, etc.)
F. Other specify: __________________________________________
2. Did any injury received while you were deployed result in any of the following? (check all that apply):
A. Being dazed, confused or “seeing stars” NOTE: Endorsement of A-E meets criteria for positive TBI Screen
B. Not remembering the injury
C. Losing consciousness (knocked out) for less than a minute
D. Losing consciousness for 1-20 minutes
E. Losing consciousness for longer than 20 minutes
F. Having any symptoms of concussion afterward
NOTE: Confirm F and G through clinical interview (such as headache, dizziness, irritability, etc.)
G. Head Injury
H. None of the above
3. Are you currently experiencing any of the following problems that you think might be related to a possible head injury or concussion? (check all that apply):
A. Headaches E. Ringing in the ears
B. Dizziness F. Irritability
C. Memory problems G. Sleep problems
D. Balance problems H. Other specify:_____________________
Screening Instructions
Question 1: A checked [√ ] response to any item A through F verifies injury.
Question 2: A checked [√ ] response to A-E meets criteria for a positive (+) screen. Further interview is indicated. A positive response to F or G does not indicate a positive screen, but should be further evaluated in a clinical interview.
Question 3: Endorsement of any item A-H verifies current symptoms which may be related to an MTBI if the screening and interview process determines a MTBI occurred.
Significance of Positive Screen
A service member who endorses an injury [Question 1], as well as an alteration of consciousness [Question 2 A-E], should be further evaluated via clinical interview because he/she is more highly suspect for having sustained an MTBI or concussion. The MTBI screen alone does not provide diagnosis of MTBI. A clinical interview is required.
Schwab, K. A., Baker, G., Ivins, B., Sluss-Tiller, M., Lux, W., & Warden, D. (2006). The Brief Traumatic Brain Injury Screen (BTBIS): Investigating the validity of a self-report instrument for detecting traumatic brain injury (TBI) in troops returning from deployment in Afghanistan and Iraq. Neurology, 66(5)(Supp. 2), A235.
For more information contact: Telephone: 1-800-870-9244 Email: info@DVBIC.org Web: www.DVBIC.org
