Isolated Severe Traumatic Brain Injuries Sustained During Combat Operations: Demographics, Mortality Outcomes, and Lessons to be Learned From Contrasts to Civilian Counterparts

Abstract

Patients sustaining severe traumatic brain injury during military operations represent a unique population. Comparison with civilian counterparts has inherent limitations but reveals higher rates of neurosurgical intervention performed after penetrating injuries and a corresponding improvement in survival. Many factors likely contribute to these findings, which highlight the need for additional research on the optimal management of penetrating brain injury.

Changes in cognition and continence as predictors of rehabilitation outcomes in individuals with severe traumatic brain injury

“…Reportedly, from 2004 to 2008, the ratio of moderate TBI to STBI as the result of penetrating versus closed-head trauma in Iraq and Afghanistan was >2:1; however, the ratio changed to 1.3:1 in 2008 to 2010, possibly due to improvements in the use of protective measures and tactics and/or progress in diagnosis of closed-head TBIs [3]. Reportedly, veterans with TBI are significantly more likely to undergo intracranial pressure monitoring and operative neurosurgical intervention than civilians [48], which may improve outcomes [35][36]. However, in this case series, all participants had intracranial pressure monitoring and two underwent neurosurgical procedures that included a craniectomy and a craniotomy.…”

Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury

“…Penetrating head trauma does occur among combat veterans but is far less frequent than either injury from blunt injury or blast exposure. From September 2001 through September 2007, penetrating head trauma accounted for 11 percent of the 2,898 military hospital admissions for U.S. Army soldiers deployed to Afghanistan or Iraq [40], and a similar evaluation of Joint Theater Trauma Registry patients with TBI from 2003 through 2007 showed penetrating trauma in 18.5 percent [41]. These percentages represent upper bounds for penetrating trauma cases because they are based on military medical facility admissions, and therefore do not include many mTBI cases that were not evaluated by a military physician.…”

Does the Declining Lethality of Gunshot Injuries Mask a Rising Epidemic of Gun Violence in the United States?

“…6,7 For example, aggressive intracranial pressure monitoring and frequent neurosurgical intervention among victims of battlefield blast and penetrating injury has been demonstrated to improve mortality, a practice which has translated to civilian care. 8 Similarly, early and even preemptive correction of coagulopathy (e.g., through use of recombinant factor VIIa) in battlefield victims has been demonstrated to result in fewer transfusions with no increase in thrombosis, providing valuable information for civilians suffering gunshot injury. 9,10 More generally, many of the improvements in the quality of civilian traumatic care have followed advances made in major military conflicts.…”