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GovernmentExecutive.com published an interesting article last week that raised some serious questions about how the military decides which assessment tool they're going to use in combat situations. Sounds to me like something funny was going on with their latest study (results have never been published); maybe they didn't like the results? Here's an excerpt:
Senior Defense Department officials have stressed repeatedly in public they are doing everything they can to provide the best care possible to U.S. troops injured in Iraq and Afghanistan. But that might not be the case for the tens of thousands of troops who have experienced some form of brain injury.

Four years ago, a group of Air Force doctors treating wounded soldiers at field hospitals in Iraq sought a better way to evaluate the impact of blast injuries on soldiers' brains when there were no visible head wounds -- a condition known as mild traumatic brain injury. Mild TBI can be deceptive, because it often occurs without any outward signs of trauma. A soldier can recover completely from mild TBI, but left undiagnosed and untreated, it can lead to serious impairment over time, especially if the individual is exposed to additional blasts later on.

Lacking an adequate tool to help determine when it was safe to send soldiers back to combat, Air Force doctors in 2006 began using an off-the-shelf, Web-enabled assessment tool called the Cognitive Stability Index, developed by a small, New York-based company called Headminder. At least one of the Air Force doctors had used it before, liked it, and believed it could work well in the field.

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The Air Force doctors in Iraq were impressed enough with the CSI's clinical performance in the field that they sought and received approval from a military institutional review board to conduct a scientific study comparing the CSI to two other tools the military uses: a computer-based tool the Army developed in 1984, called the Automated Neuropsychological Assessment Metrics; and a basic screening tool developed by military medical personnel in 2006 called the Military Acute Concussion Evaluation.

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What happened next with the study is the subject of some disagreement among those with knowledge of it.

What is undisputed is the data from the 2006-2007 combat study has never been published in a peer-reviewed journal, an essential step in validating the teams' findings. Without such review by disinterested peer scientists, the doctors' findings and conclusions are in limbo.

Jeffrey Barth, chief of medical psychology at the University of Virginia School of Medicine and medical director of the school's Neuropsychology Assessment Laboratories, is an expert in mild traumatic brain injury and served as an outside adviser on the study. He said he doesn't know why the study was never published, or if it was even completed. "We certainly had sufficient data to put together [a manuscript for] publication," he said. "All I know is we were writing an article and the last I heard about it [was] in the middle of 2008."

In a May 28, 2008, memo, then-assistant secretary of Defense for health affairs Dr. S. Ward Casscells directed all three service chiefs to immediately begin using ANAM as the assessment tool of choice "until ongoing studies to obtain evidence-based outcomes of various neurocognitive assessment tools are completed."

"The issue here would be, did the DoD know there was a superior product available?" Barth said. He doesn't know the answer to that. "This particular paper these folks were writing, which I was reviewing and being a consultant on, did show in a sort of head-to-head evaluation that CSI from Headminder did a better job in correlation with the RBANS than the ANAM did," he said. If the study had been sent out for review, "and if those peers ... thought that the findings were correct ... that would at least be one piece of information the Department of Defense should want to utilize in determining what they're going to use in theater."

Read the complete article here. (It's kind of long but quite interesting.) And whatever is, or was, going on with that study, I certainly hope that those in charge keep the welfare of our service men and women at the forefront of their decisions. Cost-cutting or favoritism deserve no place in selecting the best assessment tool possible. Our troops are giving a lot; they have earned the best medical care this country can provide.

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