Changes in TBI Assessments Will Lead to Faster Treatment

By Sarah Heynen
DCoE

January 30, 2010 - Pending changes to the in-theater mild traumatic brain injury (TBI) clinical practice guidelines (CPGs) are expected to be released in the coming weeks, drastically changing the system from a symptom-based approach to an incident-based approach.

Air Force Col. Michael Jaffee, national director of the Defense and Veterans Brain Injury Center (DVBIC) presented on the topic of TBI clinical practice guidelines and guidance at the 2010 MHS Conference Jan. 27. “There is a lot of movement in this field, especially in this past year,” he said.

The first guidelines used to assess mild TBIs among service members in theater were established in 2007 and required the injured person to come forward with symptoms. New guidelines will require that anyone involved in certain incidents – including all personnel involved in a severe vehicle accident, all personnel within 50 meters of a blast, anyone that sustains a direct blow to the head or loss of consciousness, and command directed referrals – must be screened.

This new approach will allow for earlier intervention, ensuring that the injured service member gets treated sooner. Additionally, line leaders will be the first to assess the individuals before sending on to medical assessment.

Additionally, the new guidelines will change how recurring concussions (also known as mild TBI) are treated in theater.

“There is an emerging body of evidence that we’ve seen from some NFL [National Football League] studies that indicate cumulative affects of recurring concussions over time,” Jaffee said. “The NCAA [National Collegiate Athletic Association] studies suggested increased risk with three or more, but more evidence is needed to better inform and modify our practice.”

Following a similar practice by the Marine Corps, the revised guideline will require that anyone with three mild TBIs within 12 months will go through a standard, thorough assessment. The first concussion evaluation and treatment will follow the CPG practices in place. The second concussion will have the injured service member on a seven-day mandatory rest. The third will provide a much more comprehensive neurological assessment including both a comprehensive neurological examination and occupational therapy.

What determines a mild TBI?

“A traumatic brain injury is a force applied to the head that results in an alteration or loss of consciousness,” Jaffee said. He further explained that classifying the severity of a TBI as mild, moderate or severe is based on the history of what happened at the time of the injury or how long someone had an alteration of consciousness or loss, or how long someone has post-traumatic amnesia.

“It’s not a judgment of how impaired you are, it is actually a system that was designed talking about the characteristics of the injury that happened acutely,” said Jaffee. “And there is also some imaging that correlates.”

DVBIC is a network of Department of Defense and Veterans Affairs centers with the mission is to serve active duty military, their beneficiaries, and veterans with traumatic brain injuries through state-of-the-art clinical care, innovative clinical research initiatives and educational programs. DVBIC is designated as the primary operational TBI component of Defense Centers of Excellence. To learn more about TBIs, visit http://www.dvbic.org/