Introduction
Traumatic brain injury (TBI) is a major health issue for service members deployed
and is more common in recent conflicts; however, a thorough understanding of risk
factors and trends is not well described. This study aims to characterize the epidemiology
of TBI in U.S. service members and the potential impacts of changes in policy, care,
equipment, and tactics over the 15 years studied.
Methods
Retrospective analysis of U.S. Department of Defense Trauma Registry data (2002–2016)
was performed on service members treated for TBI at Role 3 medical treatment facilities
in Iraq and Afghanistan. Risk factors and trends in TBI were examined in 2021 using
Joinpoint regression and logistic regression.
Results
Nearly one third of 29,735 injured service members (32.4%) reaching Role 3 medical
treatment facilities had TBI. The majority sustained mild (75.8%), followed by moderate
(11.6%) and severe (10.6%) TBI. TBI proportion was higher in males than in females
(32.6% vs 25.3%; p<0.001), in Afghanistan than in Iraq (43.8% vs 25.5%; p<0.001), and in battle than in nonbattle (38.6% vs 21.9%; p<0.001). Patients with moderate or severe TBI were more likely to have polytrauma
(p<0.001). TBI proportion increased over time, primarily in mild TBI (p=0.02), slightly in moderate TBI (p=0.04), and most rapidly between 2005 and 2011, with a 2.48% annual increase.
Conclusions
One third of injured service members at Role 3 medical treatment facilities experienced
TBI. Findings suggest that additional preventive measures may decrease TBI frequency
and severity. Clinical guidelines for field management of mild TBI may reduce the
burden on evacuation and hospital systems. Additional capabilities may be needed for
military field hospitals.
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Article info
Publication history
Published online: March 02, 2023
Publication stage
In Press Journal Pre-ProofIdentification
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Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
