The Boston Assessment of Traumatic Brain Injury Lifetime, Second Edition (BATL-2): Development and Initial Psychometric Evaluation in Post-9/11 Military Veterans

J Head Trauma Rehabil. 2025 Oct 1. doi: 10.1097/HTR.0000000000001112. Online ahead of print.

ABSTRACT

OBJECTIVE: Describe the development and initial psychometric evaluation of the Boston Assessment of Traumatic Brain Injury (TBI) Lifetime, Second Edition (BATL-2).

SETTING: The Translational Research Center for TBI and Stress Disorders (TRACTS) located at two large VA medical centers.

PARTICIPANTS: Random selection of 100 US post-9/11 military Veterans enrolled at TRACTS Boston primary site and 20 Veterans enrolled at TRACTS Houston secondary site.

DESIGN: Secondary analysis of a prospective longitudinal cohort study.

MAIN MEASURES: Boston Assessment of TBI-Lifetime (BAT-L), BATL-2, Ohio State University Traumatic Brain Injury Identification Method (OSU-TBI-ID).

RESULTS: BATL-2 instrument development included National Institute of Neurological Disorders and Stroke (NINDS) and American Congress of Rehabilitation Medicine (ACRM) field updates to TBI diagnostics, iterative review and feedback from stakeholders, and data-driven revisions. The BATL-2 demonstrated excellent diagnostic agreement with TBI diagnosis from the OSU-TBI-ID (κ = 0.94; sensitivity 100%; specificity 87.0%-92.5%). Internal consistency and diagnostic agreement between BATL-2 and the first edition BAT-L were high (Cronbach’s α = 0.83; κ = 0.94). BATL-2 demonstrated convergent validity with neurobehavioral symptoms (r = .260, p = .012) and discriminant validity with measures of depression (r = .004, p = .966) and tobacco use (r = .086 to .307, p > .553). Replication in a secondary sample showed robust diagnostic agreement (κ = 0.97).

CONCLUSIONS: Results indicate that the BATL-2 is a valid and reliable measure of retrospective TBI diagnosis. Importantly, BATL-2 provides continuity of evidence-based assessment of TBI, including forward compatibility with updated field TBI diagnostic criteria while maintaining backward compatibility with BAT-L and previous TBI guidelines. The BATL-2 improves retrospective brain injury characterization by reducing administration time burden, assessing repetitive head impacts (RHI) and military occupational blast exposures (MOBE), and incorporating updated field standards.

PMID:41051978 | DOI:10.1097/HTR.0000000000001112