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

Bradley A Dengler; Yll Agimi; Katharine Stout; Krista L Caudle; Kenneth C Curley; Sarah Sanjakdar; Malena Rone; Brian Dacanay; Jonathan C Fruendt; James B Phillips; Ana-Claire L Meyer

doi:10.1097/TA.0000000000003497

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

J Trauma Acute Care Surg. 2022 Aug 1;93(2):220-228. doi: 10.1097/TA.0000000000003497. Epub 2021 Dec 14.

Authors

Bradley A Dengler¹, Yll Agimi, Katharine Stout, Krista L Caudle, Kenneth C Curley, Sarah Sanjakdar, Malena Rone, Brian Dacanay, Jonathan C Fruendt, James B Phillips, Ana-Claire L Meyer

Affiliation

¹ From the Department of Neurosurgery (B.A.D.), Walter Reed National Military Medical Center, Bethesda, Maryland; Traumatic Brain Injury Center of Excellence (Y.A., K.S.), Defense Health Agency; General Dynamics Information Technology (Y.A., K.C.C.), Falls Chruch, Virginia; Warfighter Brain Health Project Management Office (K.L.C., K.C.C., S.S., M.R., B.D.), US Army Medical Materiel Development Activity, Fort Detrick, Maryland; Clinical Support Branch, Medical Capability Development and Integration Directorate (J.C.F.), Futures and Concepts Center, Army Futures Command, Austin, Texas; Combat Casualty Care Research Program (J.B.P.), and Office of the Principal Assistant for Acquisition (A.-C.L.M.), US Army Medical Research and Development Command (USAMRDC), Fort Detrick, Maryland.

PMID: 34908023
DOI: 10.1097/TA.0000000000003497

Abstract

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.

Level of evidence: Prognostic and Epidemiologic; Level III.

MeSH terms

Blast Injuries* / diagnosis
Brain Concussion* / complications
Brain Injuries, Traumatic* / diagnosis
Brain Injuries, Traumatic* / epidemiology
Brain Injuries, Traumatic* / therapy
Humans
Military Personnel*
Multiple Trauma* / complications
Retrospective Studies
Stress Disorders, Post-Traumatic* / diagnosis