TRAUMATIC BRAIN INJURY
Definition of Mild Traumatic
Brain Injury
More than 1.5 million U.S. military personnel have deployed to Iraq or Afghanistan since the start of military operations in 2001. Because of improved protective equipment, a higher percentage of soldiers are surviving injuries that would have been fatal in previous wars.1 Head and neck injuries, including severe brain trauma, have been reported in one quarter of service members who have been evacuated from Iraq and Afghanistan.1,2 Concern has been emerging about the possible long-term effect of mild traumatic brain injury, or concussion, characterized by brief loss of consciousness or altered mental status, as a result of deployment-related head injuries, particularly those resulting from proximity to blast explosions. Traumatic brain injury has been labeled a signature injury of the wars in Iraq and Afghanistan.
The exact proportion of troops who have mild traumatic brain injury is not known, although it has been reported to be as high as 18% in news articles citing army medical officials.Many troops reportedly have persistent postconcussive symptoms, such as irritability, memory problems, headache, and difficulty concentrating. As a result, the Department of Defense and the Department of Veterans Affairs are implementing new population-screening procedures for mild traumatic brain injury.
Despite these steps, little is known about the epidemiology of mild traumatic brain injury during deployment and its association with adverse health outcomes after deployment. The bulk of the literature on mild traumatic brain injury has been based on civilian patients treated in clinics or hospitals, has not been population-based, and has lacked adequate comparison groups, such as persons with other types of injuries. It is not known whether population screening for mild traumatic brain injury could improve health outcomes, and there are conflicting guidelines for treating mild traumatic brain injury
The case definition of mild traumatic brain injury that is being adopted by the new Department of Defense and Department of Veterans Affairs screening programs8,9 is consistent with national surveillance definitions. However, the use of this definition for clinical screening weeks or months after concussive events, such as during the period after deployment, has not been evaluated. The definition may not be sufficiently specific for the combat environment, where acute signs of concussion, such as alteration of mental status (e.g., being dazed or confused), may overlap with dissociative symptoms of acute stress disorder, or for the postcombat period, during which postconcussive symptoms may overlap with symptoms of post-traumatic stress disorder (PTSD) and other disorders
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