The standard tool the military services use to measure traumatic brain injury on the battlefield fails between 25 percent and 33 percent of the time, Army Surgeon General Lt. Gen. Eric Schoomaker told lawmakers on the House Armed Services Committee Tuesday.
In response to a question from freshman Rep. Joe Heck, R-Nev., an Army reserve doctor who served in Iraq, Schoomaker said the Automated Neuropsychological Assessment Metrics, known as ANAM, "is insensitive and nonspecific. It misses about a quarter to a third of [troops] who are concussed and includes about 50 percent of [troops] not concussed."
Read the entire Broken Warriors series. This dovetails with an investigation by Government Executive last May that described problems with ANAM, which the Military Health System directed all the services use in 2008.
Schoomaker told the committee that the Army is conducting a head-to-head evaluation comparing the performance of ANAM with another brain injury assessment tool, Immediate Post-Concussion Assessment and Cognitive Testing, known as ImPACT, a tool the National Football League uses to assess brain injuries in its players. Schoomaker did not say when those tests will be finished.
These tests do not include another diagnostic tool, the Cognitive Stability Index, developed by a small, New York-based company called PanMedix. Don Comrie, the company's CEO, said PanMedix declined to participate in the evaluation because the Defense Department tests were designed to evaluate sports-related injuries and not more serious combat injuries
Schoomaker told Heck the Army has no definitive test to detect traumatic brain injury on the battlefield short of a clinical diagnosis. TBI, which can result when troops are exposed to explosions, is considered a "signature" wound of the wars in Iraq and Afghanistan. It often goes undiagnosed because brain damage still can occur in the absence of visible head wounds or concussion.
Last year the Naval Special Warfare Group, which includes the elite SEALS, signed a contract with ImPACT Applications Inc. of Pittsburgh to use the tool. Internal Army documents provided to Nextgov reveal that in March 2010, the Army Special Operations Command deicide to use both ANAM and imPACT as brain injury assessment tools.
Steven Broglio, a professor in the kinesiology and community health department at the University of Illinois at Urbana-Champaign, reported in 2007 that imPACT had a 34 percent false-positive rate.
Heck told the hearing that based on his combat experience, yet another TBI screening tool, the Military Acute Concussion Evaluation, also has serious flaws. Heck said soldiers he served with who "had their bells rug too many times" by blasts had memorized the test, allowing them to ace the MACE and return to battle.
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