Injury severity at presentation is not associated with long-term vocational outcome in British Military brain injury

Bahadur, Sardar; McGilloway, Emer; Etherington, John

doi:10.1136/jramc-2014-000393

Cited by 11 publications

(4 citation statements)

References 10 publications

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“…Accurate prognostication in combat TBI is challenging, particularly early after injury, and high injury severity at presentation is not necessarily associated with long-term poor functional outcome. Of a cohort of UK military patients recorded at presentation to have severe TBI, >70% were in paid employment at 3-year follow-up 40 41. To further complicate decision making, with appropriate support, many patients living with severe disablement after TBI express satisfaction with quality of life 40…”

Section: Discussionmentioning

confidence: 99%

Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts

Breeze

Bowley

Harrisson

et al. 2020

J Neurol Neurosurg Psychiatry

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IntroductionTraumatic brain injury (TBI) is the most common cause of death on the modern battlefield. In recent conflicts in Iraq and Afghanistan, the US typically deployed neurosurgeons to medical treatment facilities (MTFs), while the UK did not. Our aim was to compare the incidence, TBI and treatment in US and UK-led military MTF to ascertain if differences in deployed trauma systems affected outcomes.MethodsThe US and UK Combat Trauma Registries were scrutinised for patients with HI at deployed MTFs between March 2003 and October 2011. Registry datasets were adapted to stratify TBI using the Mayo Classification System for Traumatic Brain Injury Severity. An adjusted multiple logistic regression model was performed using fatality as the binomial dependent variable and treatment in a US-MTF or UK-MTF, surgical decompression, US military casualty and surgery performed by a neurosurgeon as independent variables.Results15 031 patients arrived alive at military MTF after TBI. Presence of a neurosurgeon was associated with increased odds of survival in casualties with moderate or severe TBI (p<0.0001, OR 2.71, 95% CI 2.34 to 4.73). High injury severity (Injury Severity Scores 25–75) was significantly associated with a lower survival (OR 4×104, 95% CI 1.61×104 to 110.6×104, p<0.001); however, having a neurosurgeon present still remained significantly positively associated with survival (OR 3.25, 95% CI 2.71 to 3.91, p<0.001).ConclusionsPresence of neurosurgeons increased the likelihood of survival after TBI. We therefore recommend that the UK should deploy neurosurgeons to forward military MTF whenever possible in line with their US counterparts.

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Section: Discussionmentioning

confidence: 99%

Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts

Breeze

Bowley

Harrisson

et al. 2020

J Neurol Neurosurg Psychiatry

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show abstract

“…Debido a la gravedad y el difícil manejo de las lesiones generadas por estos artefactos, en comparación con otras armas convencionales, se han evidenciado altas cifras de mortalidad y discapacidad física, visual, auditiva y psicológica en las víctimas. Esto además causa un fuerte impacto socioeconómico y cultural en la comunidad 14,34,45 .…”

Section: Principales Efectos De Enfermedad O Lesión Reportados En Las...unclassified

Alteraciones de la salud humana por artefactos explosivos improvisados. Revisión sistemática exploratoria

Parra-Castañeda,

Orjuela-Candela,

Daza Corba

et al. 2024

MedUPB

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Objetivo: revisar la literatura existente indagando por los tipos de lesión o enfermedad que se han identificado en supervivientes de artefactos explosivos improvisados (AEI), así como aspectos individuales y colectivos relacionados con la protección o destrucción de la salud humana enfrentada a los AEI. Metodología: revisión sistemática exploratoria de literatura publicada en bases de datos, como PubMed, SciELO, LILACS, JSTOR, OpenGrey y Google Scholar, entre 2001 a 2021 en cualquier localización geográfica. Se incluyeron artículos de investigación, de revisión o reflexión, libros o capítulos de libro de investigación e informes técnicos, en inglés, español, francés y portugués. Resultados: cumplieron con los criterios de inclusión y fueron revisados 76 documentos. Se han reportado múltiples lesiones asociadas al uso de los AEI, sin que exista un patrón característico de lesión o enfermedad; no obstante, la lesión más común es la amputación bilateral de miembros inferiores. En supervivientes se ha encontrado que el personal militar afectado suele mostrar una mayor capacidad de resiliencia, calidad de vida, tratamiento oportuno y capacidad física funcional más alta, comparado con civiles. El apoyo social genera efectos positivos en la salud y bienestar de los afectados. Conclusiones: los AEI generan múltiples afectaciones a la salud humana, físicas y psicosociales, los cuales requieren una atención integral y multidisciplinaria para el tratamiento, rehabilitación y reintegración de los supervivientes. Los aspectos protectores y destructivos identificados se encuentran asociados a mejores o peores resultados en la salud, existe una representación desigual entre civiles y militares.

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“…63 These observations are consistent with the inaccuracy of the 'fatal score' band (ISS¼75) in individuals after blast injury; up to 47% of patients undergoing neurorehabilitation after blast injury were predicted to have sustained non-survivable injuries, yet 15/16 individuals with ISS75 returned to full-or part-time employment within 4 months of discharge from rehabilitation. 64 Estimating the accuracy of scoring systems after blast injury in relation to post-mortem findings may be more comprehensive, but risks introducing further bias by missing injuries that are not clinically or visually apparent in survivors.…”

Section: Military Refinement Of Abbreviated Injury Scale Scores For Blast Injurymentioning

confidence: 99%

Injury scoring systems for blast injuries: a narrative review

Hazell

Péarce

Hepper

et al. 2022

British Journal of Anaesthesia

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Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blastspecific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.

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Injury severity at presentation is not associated with long-term vocational outcome in British Military brain injury

Cited by 11 publications

References 10 publications

Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts

Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts

Alteraciones de la salud humana por artefactos explosivos improvisados. Revisión sistemática exploratoria

Injury scoring systems for blast injuries: a narrative review

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