Role of Department of Defense Policies in Identifying Traumatic Brain Injuries Among Deployed US Service Members, 2001–2016

Agimi, Yll; Regasa, Lemma Ebssa; Ivins, Brian; Malik, Saafan; Helmick, Katherine; Marion, Donald W.

doi:10.2105/ajph.2018.304347

Cited by 20 publications

(12 citation statements)

References 17 publications

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“…In 2010, the Directive Type Memorandum (09-033) established event-based mTBI screening across the deployed force and was followed by the fragmentary order 09-1656 that linked reporting of TBI and significant operational events. 27 Blasts were the most common cause of TBI sustained in combat. As has been reported by others, higher OPTEMPO led to increased severity of brain injuries and higher workloads at role 3 facilities.…”

Section: Discussionmentioning

confidence: 99%

“…For example, in July 2006, the All Army Activities Message (143/2006) encouraged Army commanders to medically evaluate soldiers with suspected TBI and mTBI symptoms. In 2010, the Directive Type Memorandum (09-033) established event-based mTBI screening across the deployed force and was followed by the fragmentary order 09-1656 that linked reporting of TBI and significant operational events 27 …”

Section: Discussionmentioning

confidence: 99%

“…After grouping procedures into categories and roles of care, there were 55,304 procedures of which 41,813 were most relevant to providing trauma care to individuals with TBI. More than 65% (27,344) of the procedures were performed at role 3 and 26% (10,954) were performed at role 4 CONUS or OCONUS. Lower proportions of individuals with mTBI had diagnostic or surgical procedures than individuals with severe TBI except for neuropsychological testing (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…3). Individuals who were evacuated to role 4 had higher days in care [13 (IQR 7,27)] than individuals who were able to be cared for at roles 1 to 3 [8 (IQR 5,15)]. This difference was also evident among individuals with isolated mTBI and severe TBI (Appendix 4, http://links.lww.com/TA/C235).…”

Section: Return To Duty and Lost Duty Daysmentioning

confidence: 96%

See 3 more Smart Citations

Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: Implications for future military operations

Dengler

Agimi

Stout

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Traumatic brain injury (TBI) is prevalent and highly morbid among Service Members. A better understanding of TBI epidemiology, outcomes, and care patterns in deployed settings could inform potential approaches to improve TBI diagnosis and management. METHODS:A retrospective cohort analysis of Service Members who sustained a TBI in deployed settings between 2001 and 2018 was conducted. Among individuals hospitalized with TBI, we compared the demographic characteristics, mechanism of injury, injury type, and severity between combat and noncombat injuries. We compared diagnostic tests and procedures, evacuation patterns, return to duty rates and days in care between individuals with concussion and those with severe TBI. RESULTS:There were 46,309 service members with TBI and 9,412 who were hospitalized; of those hospitalized, 55% (4,343) had isolated concussion and 9% (796) had severe TBI, of whom 17% (132/796) had multiple injuries. Overall mortality was 2% and ranged from 0.1% for isolated concussion to 18% for severe TBI. The vast majority of TBI were evacuated by rotary wing to role 3 or higher, including those with isolated concussion. As compared with severe TBI, individuals with isolated concussion had fewer diagnostic or surgical procedures performed. Only 6% of service members with severe TBI were able to return to duty as compared with 54% of those with isolated concussion. Traumatic brain injury resulted in 123,677 lost duty days; individuals with isolated concussion spent a median of 2 days in care and those with severe TBI spent a median of 17 days in care and a median of 6 days in the intensive care unit. CONCLUSION:While most TBI in the deployed setting are mild, TBI is frequently associated with hospitalization and multiple injuries. Overtriage of mild TBI is common. Improved TBI capabilities applicable to forward settings will be critical to the success of future multidomain operations with limitations in air superiority.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Return To Duty and Lost Duty Daysmentioning

confidence: 96%

See 2 more Smart Citations

Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: Implications for future military operations

Dengler

Agimi

Stout

et al. 2021

J Trauma Acute Care Surg

Self Cite

View full text Add to dashboard Cite

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“…Perceived stigma, a "tough it out" military mentality, con dentiality issues, commitment to duty/mission, and challenges with navigating the military healthcare system all contribute to underreporting. [5][6][7] In 2006, the military services and Department of Defense (DoD) instituted a number of policies initiating screening measures to address underreporting and under-documentation of TBI among deployed service members. 8 In 2010, the DoD further mandated in-theater "event driven" TBI protocols for those who were within 50 meters of any blast explosion, were in a vehicle associated with a blast event, collision/rollover, or sustained a direct blow to the head, 9,10 In addition to screening measures and in-theater TBI protocols, the Post-Deployment Health Assessment (PDHA) was mandated to be administered to all being demobilized following deployment.…”

Section: Introductionmentioning

confidence: 99%

Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime and In-Theater Department of Defense Medical Records

Kim

Currao

Fonda

et al. 2021

Preprint

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Background: Since 2006, efforts have been made to increase the identification of traumatic brain injuries (TBIs) in post-9/11 military personnel. The BAT-L is the first validated instrument to diagnose TBIs throughout the lifespan in post-9/11 Veterans. The objective is to investigate the correspondence of the Boston Assessment of TBI-Lifetime (BAT-L) diagnostic prevalence and injury severity of traumatic brain injury with in-theater medical records from Department of Defense (DoD). Methods: A convenience sample of 153 Veterans deployed in 2011 enrolled in the TRACTS longitudinal cohort study was examined. Retrospective review of DoD online medical records to determine diagnostic prevalence and injury severity for all head injury cases during deployment were compared with diagnostic prevalence and injury severity from the BAT-L clinical interview using Chi-square analyses.Results: There was moderate correspondence for TBI diagnosis between the BAT-L and DoD records (κ = 0.42). Sensitivity was 72.7% and specificity was 82.8%. Comparison of injury severity also had moderate correspondence (κ = 0.41). Missing TBI diagnostic data from DoD records was frequent; 43% percent of TBIs reported on the BAT-L did not have any documentation of mTBI assessment or diagnosis in DoD records while 83% did not have in-theater documentation.Conclusions: Diagnosis of TBI via the BAT-L retrospective interview was both sensitive and specific when compared to DoD medical records. However, diagnostic correspondence was only moderate. This lack of diagnostic agreement was related to multiple factors including lack of documentation of injury, differences in assessment tools and goals, and other combat-related motivational factors associated with failure to report injuries while deployed. Several policies were implemented to address underreporting and under-documentation of TBI, yet challenges remain. Findings suggest changes at both individual-level (e.g. service members) and system-level (e.g. DoD/military branches) are needed to adequately diagnose and document all TBI during deployment.

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Traumatic Brain Injury

Adams

Brostow

Brenner

2023

Veteran and Military Mental Health

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Role of Department of Defense Policies in Identifying Traumatic Brain Injuries Among Deployed US Service Members, 2001–2016

Abstract: Department of Defense and service-specific policies introduced between 2006 and 2013 significantly increased the number of battlefield TBIs identified, successfully improving the longstanding problem of underreporting of TBIs.

Cited by 20 publications

References 17 publications

Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: Implications for future military operations

Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: Implications for future military operations

Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime and In-Theater Department of Defense Medical Records

Traumatic Brain Injury

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