Table 2.

Review on traumatic brain injury in United States Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Hispanic veteran.

Study	Study Design, Population Sample	Sample Size (% Hispanic)	TBI Definition	Assessment	Outcomes	Critique
Patil et al. [40]	Retrospective cohort study Midwestern VA Polytrauma Network Site	246 (19%)	VA’s TBI screening. DoD TBI’s definition	Self-reported head pain occurring 30 days prior to initial MTBI screening. Headache severity: Neurobehavioral Symptoms Inventory (0 = none; 4 = almost always)	45% diagnosed with migraine headaches. 20% diagnosed with chronic daily headaches. 92% reported some level of sleep disturbances. Treatment: Triptan (68%) and anticonvulsant (55%), and tricyclic (40%). Headache rating did not differ by ethnicity (Hispanic/Latino vs. non-Hispanic/Latino) or marital status (married vs. unmarried)	Small sample size. Self-report data (not a valid instrument) for headaches. Low follow up (missing chart information)
Ettenhofer et al. [39]	Retrospective, cross-sectional design. VA Greater Los Angeles Healthcare System, GLA Polytrauma Network.	57 (21.4%)	VA’s TBI screening. TBI’s definition. Based on LOC or PTA: 1 = mild without LOC or PTA; 2 = mild with LOC or PTA; 3 = moderate for LOC and/or PTA; 4 = severe for LOC > 24 h and/or PTA > 7 days	Medical chart review. Clinical interview. Self-report inventory of PCS (Neurobehavioral Symptom Inventory). Battery of neuropsychological test.	Post concussive symptoms = 34% of veterans self-reported (severe to very severe). Involvement in work and school (p = 0.45, p < 0.001). Housing insecurity (p = −0.34, p < 0.05). Clinical-rated DSM-IV GAF (p = 0.43, p < 0.01)	Small sample size. Generability: Only one Polytrauma Network. 89.5% individuals were diagnosed with PTSD. Other co-morbidities could affect the functional status (i.e., pain, sleep disturbances, etc.)
Norman et al. [37]	Retrospective, cross-sectional design	303,716 (~12%)	VA’s TBI screening. DoD TBI’s definition Severe: Normal or abnormal imaging, LOC > 24 h; AOC > 24, PTA > 7 days. Moderate: Normal or abnormal imaging, LOC > 30 min and ≤ 24 h, AOC > 24 h, PTA > 1 day and < 7 days.Mild: Normal imaging; LOC from 0–30 min, AOC is up to 24 h and PTA is from 0–1 day and unclassifiable.	ICD-9-CM code for communications disorders (aphasia, voice disorders and, fluency)	Voice disorders (3.5 per 1000). Aphasia (1.9 per 1000). Fluency disorder (0.7 per 1000). TBI with aphasia (OR = 11.09–252.75, 95% CI = 8.78–441.52, p < 0.01). TBI with fluency disorders (OR = 3.58–10.41, 95% CI = 2.56–42.40, p < 0.01). TBI and voice disorders (OR = 1.5–6.61, 95% CI = 1.24–14.05, p < 0.01)	Diagnostic bias: some veterans were only diagnosed once with communication disorders. Diagnostic categories too broad. No clear mechanism of injury, could be associated with speech-language problems
Rodgers et al. [42]	Retrospective, cross-sectional design Veterans Affairs Outpatient Level 3 Polytrauma clinic	310 (1.3%)	DoD TBI’s definition. VA’s TBI screening. Self-report TBI	Self-report of Beck Depression Inventory II (BDI-II) Score: 0 = no symptoms to 3 = severe symptoms. Total score of 21 = moderate symptoms	Mean BDI-II total score = 21.20 (SD = 11.76; range = 0–51) CFA’s models: three-factor TBI, two factor psychiatric, three-factor substance abuse, and two-factor neurorehabilitation samples. Chi-square for all models were significant (p < 0.001). Three-factor substance abuse model: reliability = 0.79 to 0.88 (best fit).	Instrument (BDI-II) was demonstrated to have a good reliability and validity in previous studies.3. Generalizability (only veterans referred to outpatient level 3polytrauma clinic. Small sample size to use CFA’s models.
Sozda et al. [38]	Cross-sectional study design Veterans Affairs Outpatient Level 3 Polytrauma clinic	103 (14%)	DoD TBI’s definition VA’s TBI screening	Wechsler Adult Intelligence Scale (WAIS-III) Digit Span subset. Delis-Kaplan Executive Functioning System. Hopskins Verbal Learning Test. Brief Visuospatial Memory Test. Beck Depression Inventory. PTSD Checklist-Military Version	Non-normality of neuropsychological (Wilsoxon’s sign ranked tests to compare median z scores of interest, and Cohen’s r effect sizes; small = 0.1, medium= 0.3, large = 0.5). Visual learning and memory abilities = intact compared to verbal learning and memory performance = reduced. Verbal learning (SD = 1.1 below the mean) and verbal memory (SD = 1.4 below the mean)	All MTBI’s were self- reported during soldier’s active duty status. Lack of methodology while identification of included/excluded patients. Controlled environment setting, Causal relationship between psychiatric symptoms, MTBI, and neuropsychological performance.