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 inBrain imaging and behavior Vol. 9; no. 3; pp. 358 - 366
Main Authors Helmick, Katherine M., Spells, Cynthia A., Malik, Saafan Z., Davies, Cathleen A., Marion, Donald W., Hinds, Sidney R.
Format Journal Article
LanguageEnglish
Published New York Springer US 01.09.2015
Springer Nature B.V
Subjects
Online AccessGet full text
ISSN1931-7557
1931-7565
1931-7565
DOI10.1007/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.
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
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  givenname: Cynthia A.
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/25972118$$D View this record in MEDLINE/PubMed
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Issue 3
Keywords Traumatic brain injury
Concussion
Surveillance
Department of Defense
Clinical recommendations
Military
Language English
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PublicationTitle Brain imaging and behavior
PublicationTitleAbbrev Brain Imaging and Behavior
PublicationTitleAlternate Brain Imaging Behav
PublicationYear 2015
Publisher Springer US
Springer Nature B.V
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References Papa L, Ramia MM, Edwards D, Johnson BD, Slobounov SM (2015) Systematic review of clinical studies examining biomarkers of brain injury in athletes after sports-related concussion. Journal of Neurotrauma, 32(10), 661–673.
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.
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
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References_xml – reference: T2 (2015): http://t2health.dcoe.mil/
– reference: 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
– reference: DeanPSterrALong term effects of mild TBI on cognitive performanceFrontiers in Human Neuroscience2013730356984410.3389/fnhum.2013.0003023408228
– reference: DVBIC Sleep CR (2014): https://dvbic.dcoe.mil/resources/management-sleep-disturbances
– reference: FrenchLMcCreaMBaggettMThe military acute concussion evaluation. (MACE)Journal of Special Operations Medicine2008816877
– reference: Institute of Medicine (IOM) and National Research Council (NRC)Sports-related concussion in youth: Improving the science, changing the culture2013WashingtonThe National Academies Press
– reference: DVBIC (2015a): http://dvbic.dcoe.mil/dod-worldwide-numbers-tbi
– reference: FrenchLMMilitary traumatic brain injury: an examination of important differencesAnnals of the New York Academy of Sciences20101208384510.1111/j.1749-6632.2010.05696.x20955324
– reference: A Head for the Future (2015): http://dvbic.dcoe.mil/aheadforthefuture
– reference: PDHA (2008): http://www.pdhealth.mil/dcs/dd_form_2796.asp
– reference: CMA (2014): https://dvbic.dcoe.mil/material/concussion-management-algorithm-cma-pocket-cards
– reference: 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
– reference: HurstHBoltonJAssessing the clinical significance of change scores recorded on subjective outcome measuresJournal of Manipulative and Physiological Therapeutics2004271263510.1016/j.jmpt.2003.11.00314739871
– reference: MacDonaldCJohnsonAWierzerchowskiLKassnerEStewartTNelsonEWernerNZoniesDOhJFangRBrodyDProspective assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evecuated US military personnelJAMA Neurology2014718994100210.1001/jamaneurol.2014.1114
– reference: PDHRA (2008): http://www.armyg1.army.mil/hr/pdhra/
– reference: CNRM (2015): http://www.usuhs.mil/cnrm/
– reference: Incident –based reporting (2010): http://dvbic.dcoe.mil/sites/default/files/uploads/Line%20Leader%20Fact%20Sheet%202012_V3_Final%20.pdf
– reference: Papa L, Ramia MM, Edwards D, Johnson BD, Slobounov SM (2015) Systematic review of clinical studies examining biomarkers of brain injury in athletes after sports-related concussion. 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
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Snippet 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...
Issue Title: Mild Traumatic Brain Injury among Active Duty Service Members and Veterans Traumatic brain injury (TBI), and particularly concussion, is a major...
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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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