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
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引用次数: 4

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.

在部署的军事环境中,创伤性脑损伤的流行病学、护理模式和结果:对未来军事行动的影响。
背景:创伤性脑损伤(TBI)在服役人员中普遍存在且发病率很高。更好地了解TBI流行病学、结果和部署环境中的护理模式可以为改进TBI诊断和管理提供潜在的方法。方法:对2001年至2018年在部署环境中遭受TBI的服务人员进行回顾性队列分析。在因TBI住院的个体中,我们比较了战斗和非战斗损伤的人口统计学特征、损伤机制、损伤类型和严重程度。我们比较了脑震荡患者和严重创伤性脑损伤患者之间的诊断测试和程序、疏散模式、重返工作岗位率和护理天数。结果:共有46,309名军人发生TBI, 9412人住院治疗;住院患者中,55%(4343)为孤立性脑震荡,9%(796)为重度脑外伤,其中17%(132/796)为多发损伤。总体死亡率为2%,范围从孤立性脑震荡的0.1%到严重TBI的18%。绝大多数TBI患者通过旋翼疏散至3级或更高级别,包括孤立性脑震荡患者。与严重的创伤性脑损伤相比,孤立性脑震荡患者较少接受诊断或手术治疗。只有6%的严重创伤性脑损伤的军人能够返回工作岗位,而孤立性脑震荡的军人有54%能够返回工作岗位。创伤性脑损伤导致123,677个工作日损失;孤立性脑震荡患者的护理时间中位数为2天,严重脑外伤患者的护理时间中位数为17天,重症监护室的护理时间中位数为6天。结论:虽然部署环境中的大多数TBI是轻微的,但TBI经常与住院和多发损伤相关。轻度创伤性脑损伤的过度分类是常见的。适用于前方设置的改进TBI能力将对未来多域作战的成功至关重要,因为空中优势有限。证据水平:预后和流行病学;第三层次。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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