Document Detail

Epidemiologic aspects of traumatic brain injury in acute combat casualties at a major military medical center: a cohort study.
MedLine Citation:
PMID:  23060246     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: From the ongoing military conflicts in Iraq and Afghanistan, an understanding of the neuroepidemiology of traumatic brain injury (TBI) has emerged as requisite for further advancements in neurocombat casualty care. This study reports population-specific incidence data and investigates TBI identification and grading criteria with emphasis on the role of loss of consciousness (LOC) in the diagnostic rubric.
METHODS: This is a cohort study of all consecutive troops acutely injured during combat operations-sustaining body-wide injuries sufficient to require immediate stateside evacuation-and admitted sequentially to our medical center during a 2-year period. A prospective exploration of the TBI identification and grading system was performed in a homogeneous population of blast-injured polytrauma inpatients.
RESULTS: TBI incidence was 54.3%. Structural neuroimaging abnormalities were identified in 14.0%. Higher Injury Severity Score (ISS) was associated with abnormal neuroimaging, longer length of stay (LOS), and elevated TBI status-primarily based on autobiographical LOC. Mild TBI patients had normal neuroimaging, higher ISS, and comparable LOS to TBI-negative patients. Patients who reported LOC had a lower incidence of abnormal neuroimaging.
INTERPRETATION: This study demonstrates that the methodology used to assign the diagnosis of a mild TBI in troops with complex combat-related injuries is crucial to an accurate accounting. The detection of incipient mild TBI, based on an identification system that utilizes LOC as the principal diagnostic criterion to discern among patients with outcomes of interest, misclassifies patients whose LOC may not reflect actual brain injury. Attempts to identify high-risk battlefield casualties within the current point-of-injury mild TBI case definition, which favors high sensitivity, will be at the expense of specificity.
Michael S Xydakis; Geoffrey S F Ling; Lisa P Mulligan; Cara H Olsen; Warren C Dorlac
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Publication Detail:
Type:  Journal Article     Date:  2012-10-11
Journal Detail:
Title:  Annals of neurology     Volume:  72     ISSN:  1531-8249     ISO Abbreviation:  Ann. Neurol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2013-01-02     Completed Date:  2013-02-19     Revised Date:  2013-10-25    
Medline Journal Info:
Nlm Unique ID:  7707449     Medline TA:  Ann Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  673-81     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Neurological Association.
Department of Surgery (Division of Otolaryngology) Traumatic Brain Injury Surgical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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MeSH Terms
Afghan Campaign 2001-
Brain Injuries / epidemiology*,  etiology
Cohort Studies
Combat Disorders / complications,  epidemiology*
Disease Progression
Glasgow Coma Scale
Hospitals, Military*
Iraq War, 2003 - 2011
Kaplan-Meier Estimate
Self Report
Unconsciousness / epidemiology*,  etiology
United States / epidemiology
Young Adult
Comment In:
Ann Neurol. 2013 Jul;74(1):152-4   [PMID:  23526742 ]
Ann Neurol. 2012 Nov;72(5):A5-6   [PMID:  23280802 ]
Ann Neurol. 2013 Jul;74(1):150-2   [PMID:  23526748 ]

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