Traumatic brain injury in the US military: epidemiology and key clinical and research programs
Traumatic brain injury (TBI), and particularly concussion, is a major concern for the U.S. Military because of the associated short term disability, long term cognitive and pain symptoms suffered by some, and risk of prolonged or permanent neurologic injury if the Service member incurs a second TBI...
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Published in | Brain imaging and behavior Vol. 9; no. 3; pp. 358 - 366 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
01.09.2015
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
ISSN | 1931-7557 1931-7565 1931-7565 |
DOI | 10.1007/s11682-015-9399-z |
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Abstract | Traumatic brain injury (TBI), and particularly concussion, is a major concern for the U.S. Military because of the associated short term disability, long term cognitive and pain symptoms suffered by some, and risk of prolonged or permanent neurologic injury if the Service member incurs a second TBI before full recovery from the first. Concussions were seen more often during the recent conflicts in Afghanistan and Iraq than in prior conflicts, such as the Vietnam War, because of the use of improvised explosive devices that typically caused non-penetrating closed head injury. Since 2000 more than 300,000 Service members were diagnosed with TBI, of which more than 80 % were concussions. Improved TBI screening tools also have identified a higher than expected incidence of concussions occurring in garrison. In this review we summarize current epidemiologic data for TBI in the Military, and describe contemporary Military procedures and strategies for TBI prevention, identification, evaluation, and acute and chronic care. Key TBI clinical research priorities and programs are described, and innovative organizational plans to address future TBI needs are summarized. |
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AbstractList | Issue Title: Mild Traumatic Brain Injury among Active Duty Service Members and Veterans Traumatic brain injury (TBI), and particularly concussion, is a major concern for the U.S. Military because of the associated short term disability, long term cognitive and pain symptoms suffered by some, and risk of prolonged or permanent neurologic injury if the Service member incurs a second TBI before full recovery from the first. Concussions were seen more often during the recent conflicts in Afghanistan and Iraq than in prior conflicts, such as the Vietnam War, because of the use of improvised explosive devices that typically caused non-penetrating closed head injury. Since 2000 more than 300,000 Service members were diagnosed with TBI, of which more than 80 % were concussions. Improved TBI screening tools also have identified a higher than expected incidence of concussions occurring in garrison. In this review we summarize current epidemiologic data for TBI in the Military, and describe contemporary Military procedures and strategies for TBI prevention, identification, evaluation, and acute and chronic care. Key TBI clinical research priorities and programs are described, and innovative organizational plans to address future TBI needs are summarized. Traumatic brain injury (TBI), and particularly concussion, is a major concern for the U.S. Military because of the associated short term disability, long term cognitive and pain symptoms suffered by some, and risk of prolonged or permanent neurologic injury if the Service member incurs a second TBI before full recovery from the first. Concussions were seen more often during the recent conflicts in Afghanistan and Iraq than in prior conflicts, such as the Vietnam War, because of the use of improvised explosive devices that typically caused non-penetrating closed head injury. Since 2000 more than 300,000 Service members were diagnosed with TBI, of which more than 80 % were concussions. Improved TBI screening tools also have identified a higher than expected incidence of concussions occurring in garrison. In this review we summarize current epidemiologic data for TBI in the Military, and describe contemporary Military procedures and strategies for TBI prevention, identification, evaluation, and acute and chronic care. Key TBI clinical research priorities and programs are described, and innovative organizational plans to address future TBI needs are summarized.Traumatic brain injury (TBI), and particularly concussion, is a major concern for the U.S. Military because of the associated short term disability, long term cognitive and pain symptoms suffered by some, and risk of prolonged or permanent neurologic injury if the Service member incurs a second TBI before full recovery from the first. Concussions were seen more often during the recent conflicts in Afghanistan and Iraq than in prior conflicts, such as the Vietnam War, because of the use of improvised explosive devices that typically caused non-penetrating closed head injury. Since 2000 more than 300,000 Service members were diagnosed with TBI, of which more than 80 % were concussions. Improved TBI screening tools also have identified a higher than expected incidence of concussions occurring in garrison. In this review we summarize current epidemiologic data for TBI in the Military, and describe contemporary Military procedures and strategies for TBI prevention, identification, evaluation, and acute and chronic care. Key TBI clinical research priorities and programs are described, and innovative organizational plans to address future TBI needs are summarized. Traumatic brain injury (TBI), and particularly concussion, is a major concern for the U.S. Military because of the associated short term disability, long term cognitive and pain symptoms suffered by some, and risk of prolonged or permanent neurologic injury if the Service member incurs a second TBI before full recovery from the first. Concussions were seen more often during the recent conflicts in Afghanistan and Iraq than in prior conflicts, such as the Vietnam War, because of the use of improvised explosive devices that typically caused non-penetrating closed head injury. Since 2000 more than 300,000 Service members were diagnosed with TBI, of which more than 80 % were concussions. Improved TBI screening tools also have identified a higher than expected incidence of concussions occurring in garrison. In this review we summarize current epidemiologic data for TBI in the Military, and describe contemporary Military procedures and strategies for TBI prevention, identification, evaluation, and acute and chronic care. Key TBI clinical research priorities and programs are described, and innovative organizational plans to address future TBI needs are summarized. Traumatic brain injury (TBI), and particularly concussion, is a major concern for the U.S. Military because of the associated short term disability, long term cognitive and pain symptoms suffered by some, and risk of prolonged or permanent neurologic injury if the Service member incurs a second TBI before full recovery from the first. Concussions were seen more often during the recent conflicts in Afghanistan and Iraq than in prior conflicts, such as the Vietnam War, because of the use of improvised explosive devices that typically caused non-penetrating closed head injury. Since 2000 more than 300,000 Service members were diagnosed with TBI, of which more than 80 % were concussions. Improved TBI screening tools also have identified a higher than expected incidence of concussions occurring in garrison. In this review we summarize current epidemiologic data for TBI in the Military, and describe contemporary Military procedures and strategies for TBI prevention, identification, evaluation, and acute and chronic care. Key TBI clinical research priorities and programs are described, and innovative organizational plans to address future TBI needs are summarized. |
Author | Hinds, Sidney R. Malik, Saafan Z. Helmick, Katherine M. Davies, Cathleen A. Marion, Donald W. Spells, Cynthia A. |
Author_xml | – sequence: 1 givenname: Katherine M. surname: Helmick fullname: Helmick, Katherine M. email: Katherine.m.helmick.civ@mail.mil organization: DVBIC/DCoE Headquarters – sequence: 2 givenname: Cynthia A. surname: Spells fullname: Spells, Cynthia A. organization: DVBIC/DCoE Headquarters – sequence: 3 givenname: Saafan Z. surname: Malik fullname: Malik, Saafan Z. organization: DVBIC/DCoE Headquarters – sequence: 4 givenname: Cathleen A. surname: Davies fullname: Davies, Cathleen A. organization: DVBIC/DCoE Headquarters – sequence: 5 givenname: Donald W. surname: Marion fullname: Marion, Donald W. organization: DVBIC/DCoE Headquarters – sequence: 6 givenname: Sidney R. surname: Hinds fullname: Hinds, Sidney R. organization: DVBIC/DCoE Headquarters |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25972118$$D View this record in MEDLINE/PubMed |
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PDHA (2008): http://www.pdhealth.mil/dcs/dd_form_2796.asp MeterkoMBakerEStolzmannKLHendricksAMCiceroneKDLewHLPsychometric assessment of the neurobehavioral symptom inventory-22: the structure of persistent postconcussive symptoms following deployment-related mild traumatic brain injury among veteransThe Journal of Head Trauma Rehabilitation2012271556210.1097/HTR.0b013e318230fb1722190009 CNRM (2015): http://www.usuhs.mil/cnrm MacDonaldCJohnsonAWierzerchowskiLKassnerEStewartTNelsonEWernerNZoniesDOhJFangRBrodyDProspective assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evecuated US military personnelJAMA Neurology2014718994100210.1001/jamaneurol.2014.1114 DVBIC (2015a): http://dvbic.dcoe.mil/dod-worldwide-numbers-tbi DVBIC Sleep CR (2014): https://dvbic.dcoe.mil/resources/management-sleep-disturbances Institute of Medicine (IOM) and National Research Council (NRC)Sports-related concussion in youth: Improving the science, changing the culture2013WashingtonThe National Academies Press FrenchLMcCreaMBaggettMThe military acute concussion evaluation. (MACE)Journal of Special Operations Medicine2008816877 NRAP 2012: The White House- National Research Action Plan (2012): http://www.whitehouse.gov/sites/default/files/uploads/nrap_for_eo_on_mental_health_august_2013.pdf DVBIC (2012): https://www.jsomonline.org/TBI/MACE_Revised_2012.pdf MarionDWCurleyKCSchwabKHicksRRmTBI Diagnostics WorkgroupProceedings of the military mTBI Diagnostics Workshop, St. Pete Beach, August 2010Journal of Neurotrauma20112845172610.1089/neu.2010.163821265587 VA (2010): http://www.va.gov/optometry/docs/vha_directive_2010-012_screening_and_evaluation_of_possible_tbi_in_oef-oif_veterans.pdf MarutaJGhajarJDetecting eye movement abnormalities from concussionProgress in Neurological Surgery2014282263310.1159/00035878624923406 MacFarlaneMPGlennTCNeurochemical cascade of concussionBrain Injury20152921395310.3109/02699052.2014.96520825587743 T2 (2015): http://t2health.dcoe.mil PDHRA (2008): http://www.armyg1.army.mil/hr/pdhra FrenchLMMilitary traumatic brain injury: an examination of important differencesAnnals of the New York Academy of Sciences20101208384510.1111/j.1749-6632.2010.05696.x20955324 ZaloshnjaEMillerTLangloisJASelassieAWPrevalence of long-term disability from traumatic brain injury in the civilian population of the United States, 2005The Journal of Head Trauma Rehabilitation200823639440010.1097/01.HTR.0000341435.52004.ac19033832 A Head for the Future (2015): http://dvbic.dcoe.mil/aheadforthefuture ANAM (2012): http://www.dcoe.mil/content/Navigation/Documents/About%20ANAM.pdf HurstHBoltonJAssessing the clinical significance of change scores recorded on subjective outcome measuresJournal of Manipulative and Physiological Therapeutics2004271263510.1016/j.jmpt.2003.11.00314739871 DeanPSterrALong term effects of mild TBI on cognitive performanceFrontiers in Human Neuroscience2013730356984410.3389/fnhum.2013.0003023408228 SCORE (2011): https://clinicaltrials.gov/ct2/show/NCT01339806 OwensBDKraghJFWenkeJCMacaitisJWadeCEHolcombJBCombat wounds in operation Iraqi freedom and operation enduring freedomThe Journal of Trauma2008642959910.1097/TA.0b013e318163b87518301189 DoD/VA Program Coordination (2013): http://www.tricare.mil/DVPCO/joint-exe.cfm RabinowitzARLevinHSCognitive sequelae of traumatic brain injuryThe Psychiatric Clinics of North America2014371111392714310.1016/j.psc.2013.11.00424529420 ScholtenJDSayerNAVanderploegRDBidelspachDECifuDXAnalysis of US veterans health administration comprehensive evaluations for traumatic brain injury in operation enduring freedom and operation Iraqi freedom veteransBrain Injury2012261011778410.3109/02699052.2012.66191422646489 Incident –based reporting (2010): http://dvbic.dcoe.mil/sites/default/files/uploads/Line%20Leader%20Fact%20Sheet%202012_V3_Final%20.pdf CENC (2014): https://cenc.rti.org CMA (2014): https://dvbic.dcoe.mil/material/concussion-management-algorithm-cma-pocket-cards DoDI 6490.11 (2012): http://www.usaisr.amedd.army.mil/assets/cpgs/DODI_6490.11_Policy_Guidance_for_Mgmt_of_Mild_Traumatic_Brain_Injury_or_Concussion_in_the_Deployed_Setting.pdf DVBIC (2015b): http://dvbic.dcoe.mil/resources L French (9399_CR14) 2008; 8 9399_CR16 9399_CR31 9399_CR1 9399_CR10 9399_CR32 9399_CR2 9399_CR3 BD Owens (9399_CR24) 2008; 64 9399_CR11 9399_CR33 9399_CR12 LM French (9399_CR13) 2010; 1208 MP MacFarlane (9399_CR19) 2015; 29 C MacDonald (9399_CR18) 2014; 71 9399_CR29 JD Scholten (9399_CR30) 2012; 26 P Dean (9399_CR6) 2013; 7 H Hurst (9399_CR15) 2004; 27 9399_CR26 9399_CR27 DW Marion (9399_CR20) 2011; 28 Institute of Medicine (IOM) and National Research Council (NRC) (9399_CR17) 2013 9399_CR25 J Maruta (9399_CR21) 2014; 28 9399_CR23 9399_CR8 9399_CR9 E Zaloshnja (9399_CR34) 2008; 23 9399_CR4 9399_CR5 9399_CR7 M Meterko (9399_CR22) 2012; 27 AR Rabinowitz (9399_CR28) 2014; 37 |
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Journal of Neurotrauma, 32(10), 661–673. – reference: RabinowitzARLevinHSCognitive sequelae of traumatic brain injuryThe Psychiatric Clinics of North America2014371111392714310.1016/j.psc.2013.11.00424529420 – reference: DoD/VA Program Coordination (2013): http://www.tricare.mil/DVPCO/joint-exe.cfm – reference: MarionDWCurleyKCSchwabKHicksRRmTBI Diagnostics WorkgroupProceedings of the military mTBI Diagnostics Workshop, St. Pete Beach, August 2010Journal of Neurotrauma20112845172610.1089/neu.2010.163821265587 – reference: ZaloshnjaEMillerTLangloisJASelassieAWPrevalence of long-term disability from traumatic brain injury in the civilian population of the United States, 2005The Journal of Head Trauma Rehabilitation200823639440010.1097/01.HTR.0000341435.52004.ac19033832 – reference: ANAM (2012): http://www.dcoe.mil/content/Navigation/Documents/About%20ANAM.pdf – reference: MeterkoMBakerEStolzmannKLHendricksAMCiceroneKDLewHLPsychometric assessment of the neurobehavioral symptom inventory-22: the structure of persistent postconcussive symptoms following deployment-related mild traumatic brain injury among veteransThe Journal of Head Trauma Rehabilitation2012271556210.1097/HTR.0b013e318230fb1722190009 – reference: VA (2010): http://www.va.gov/optometry/docs/vha_directive_2010-012_screening_and_evaluation_of_possible_tbi_in_oef-oif_veterans.pdf – reference: CENC (2014): https://cenc.rti.org/ – reference: DVBIC (2015b): http://dvbic.dcoe.mil/resources – reference: OwensBDKraghJFWenkeJCMacaitisJWadeCEHolcombJBCombat wounds in operation Iraqi freedom and operation enduring freedomThe Journal of Trauma2008642959910.1097/TA.0b013e318163b87518301189 – reference: Regasa LE, Thomas M, Gill R, Marion DW, Ivins BJ (2015) Military deployment may increase the risk for TBI following deployment. The Journal of Head Trauma Rehabilitation, in press. – reference: DVBIC (2012): https://www.jsomonline.org/TBI/MACE_Revised_2012.pdf – reference: SCORE (2011): https://clinicaltrials.gov/ct2/show/NCT01339806 – reference: MacFarlaneMPGlennTCNeurochemical cascade of concussionBrain Injury20152921395310.3109/02699052.2014.96520825587743 – reference: MarutaJGhajarJDetecting eye movement abnormalities from concussionProgress in Neurological Surgery2014282263310.1159/00035878624923406 – reference: ScholtenJDSayerNAVanderploegRDBidelspachDECifuDXAnalysis of US veterans health administration comprehensive evaluations for traumatic brain injury in operation enduring freedom and operation Iraqi freedom veteransBrain Injury2012261011778410.3109/02699052.2012.66191422646489 – ident: 9399_CR11 – volume: 1208 start-page: 38 year: 2010 ident: 9399_CR13 publication-title: Annals of the New York Academy of Sciences doi: 10.1111/j.1749-6632.2010.05696.x – volume: 8 start-page: 68 issue: 1 year: 2008 ident: 9399_CR14 publication-title: Journal of Special Operations Medicine – volume: 27 start-page: 55 issue: 1 year: 2012 ident: 9399_CR22 publication-title: The Journal of Head Trauma Rehabilitation doi: 10.1097/HTR.0b013e318230fb17 – volume: 7 start-page: 30 year: 2013 ident: 9399_CR6 publication-title: Frontiers in Human Neuroscience doi: 10.3389/fnhum.2013.00030 – ident: 9399_CR29 doi: 10.1097/HTR.0000000000000155 – ident: 9399_CR26 – ident: 9399_CR8 – ident: 9399_CR23 – volume-title: Sports-related concussion in youth: Improving the science, changing the culture year: 2013 ident: 9399_CR17 – volume: 37 start-page: 1 issue: 1 year: 2014 ident: 9399_CR28 publication-title: The Psychiatric Clinics of North America doi: 10.1016/j.psc.2013.11.004 – volume: 27 start-page: 26 issue: 1 year: 2004 ident: 9399_CR15 publication-title: Journal of Manipulative and Physiological Therapeutics doi: 10.1016/j.jmpt.2003.11.003 – volume: 29 start-page: 139 issue: 2 year: 2015 ident: 9399_CR19 publication-title: Brain Injury doi: 10.3109/02699052.2014.965208 – ident: 9399_CR2 – ident: 9399_CR4 – volume: 23 start-page: 394 issue: 6 year: 2008 ident: 9399_CR34 publication-title: The Journal of Head Trauma Rehabilitation doi: 10.1097/01.HTR.0000341435.52004.ac – ident: 9399_CR31 – ident: 9399_CR16 – ident: 9399_CR33 – ident: 9399_CR12 – ident: 9399_CR10 – ident: 9399_CR1 – volume: 28 start-page: 517 issue: 4 year: 2011 ident: 9399_CR20 publication-title: Journal of Neurotrauma doi: 10.1089/neu.2010.1638 – volume: 64 start-page: 295 year: 2008 ident: 9399_CR24 publication-title: The Journal of Trauma doi: 10.1097/TA.0b013e318163b875 – ident: 9399_CR27 – volume: 28 start-page: 226 year: 2014 ident: 9399_CR21 publication-title: Progress in Neurological Surgery doi: 10.1159/000358786 – ident: 9399_CR25 doi: 10.1089/neu.2014.3655 – ident: 9399_CR9 – ident: 9399_CR7 – ident: 9399_CR5 – ident: 9399_CR3 – volume: 71 start-page: 994 issue: 8 year: 2014 ident: 9399_CR18 publication-title: JAMA Neurology doi: 10.1001/jamaneurol.2014.1114 – volume: 26 start-page: 1177 issue: 10 year: 2012 ident: 9399_CR30 publication-title: Brain Injury doi: 10.3109/02699052.2012.661914 – ident: 9399_CR32 |
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SubjectTerms | Armed forces Biomedical and Life Sciences Biomedicine Brain Injuries - epidemiology Brain Injuries - prevention & control Brain Injuries - therapy Brain research Concussion Epidemiology Explosives Health surveillance Humans Medical imaging Military deployment Military personnel Military Personnel - statistics & numerical data Military/Veteran TBI Neuroimaging Neuropsychology Neuroradiology Neurosciences Patient Education as Topic Psychiatry Traumatic brain injury United States Veterans World War II Young adults |
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Title | Traumatic brain injury in the US military: epidemiology and key clinical and research programs |
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