Traumatic Brain Injuries: Unreported and Untreated in an Army Population

Abstract

Introduction In 2008, it was reported that 19.5% of service members previously deployed experienced a mild traumatic brain injury (mTBI). Fifty-seven percent of those did not seek medical care. It was suggested that concerns with seeking care involved confidentiality and career issues. Objective: This study addressed mTBI history, medical treatment history, and stigmas associated with mTBI/concussion. Materials and Methods An anonymous questionnaire was developed. Data collection occurred throughout March 2018 in conjunction with Brain Injury Awareness Month activities. Results All 5,174 volunteers were Army; 86% male; 87% were between 18 and 34 years old; 89% had <14 years in the military; 35% had a combat deployment; and 10% reported having one or more mTBIs in their military careers. Of the Soldiers who reported a concussion, 52% sought medical care. Of those not seeking care, 64% reported they did not think the injury required care, followed by 18% fearing negative impact on their career. Twenty-eight percent who experienced an mTBI versus 11% who have not reported that there is a stigma associated with an mTBI. Conclusions Soldiers sometimes failed to report their suspected concussions and did not seek medical care. Educational efforts may increase reporting of and medical screening for potentially concussive events. Future research to determine the ramifications of unreported and untreated mTBIs/concussions is recommended.

Optimizing Concussion Care Seeking: The Influence of Previous Concussion Diagnosis Status on Baseline Assessment Outcomes

“…In a sample of US Army service members, only 52% of soldiers who sustained a concussion reported the injury. 22 Similar unreported concussion frequencies have been described in youth ice hockey players, 63 high school athletes, 42 professional rugby union players, 24 and military service academy cadets. 53 While numerous efforts are ongoing to increase concussion reporting, 34,37,58 understanding potential negative effects associated with undiagnosed concussions 23 is important given the large number of athletes and servicemembers experiencing these injuries.…”

“…46 These findings are especially concerning given the fact that in military and civilian samples, <50% of individuals report concussions. 22,24,42,53,63 Clearly, prompt concussion diagnosis is critical. Our findings underscore the need for more targeted and effective interventions aimed at increasing timely concussion diagnosis.…”

Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime and In-Theater Department of Defense Medical Records

“…There are many potential reasons a Veteran may not report injury during deployment including lack of awareness they sustained a concussion, perceived stigma of TBI, a "battlemind" mindset related to military culture, con dentiality issues that may impact career advancement, and/or could delay returning home from deployment. 3,5,14 Among those who were evaluated for TBI in-theater and had DoD documentation of the injury, there were four Veterans who reported (BAT-L) that they were mid-mission when their TBI event occurred and screened negative on in-theater TBI medic assessment. It is possible that these Veterans did not endorse symptoms because they did not want to disrupt their mission and/or wanted to return to the eld.…”

“…Perceived stigma, a "tough it out" military mentality, con dentiality issues, commitment to duty/mission, and challenges with navigating the military healthcare system all contribute to underreporting. [5][6][7] In 2006, the military services and Department of Defense (DoD) instituted a number of policies initiating screening measures to address underreporting and under-documentation of TBI among deployed service members. 8 In 2010, the DoD further mandated in-theater "event driven" TBI protocols for those who were within 50 meters of any blast explosion, were in a vehicle associated with a blast event, collision/rollover, or sustained a direct blow to the head, 9,10 In addition to screening measures and in-theater TBI protocols, the Post-Deployment Health Assessment (PDHA) was mandated to be administered to all being demobilized following deployment.…”

Letter: A Scoping Review of Registered Clinical Studies on Mild Traumatic Brain Injury and Concussion (2000-2019)

“…First, the debate on clearly defining the spectrum of mTBI is much evident when one considers the stigma associated with the diagnosis of concussion in athletes 4 and military personnel. 5 Secondly, it is worth mentioning that since last year Clinical-Trials.gov has modified the list of terms used for the search on mTBI, so that the following synonyms are currently automatically considered in the search: brain concussion, cerebral concussion, grade 1 brain injury (with reference to the Adams Diffuse Axonal Injury Classification), score 1 brain injury (with reference to the Marshall classification and the Rotterdam score of TBI), commotion, mild concussions, concussion disorder, concussion mild, concussive injury, and traumatic encephalopathy. Individual results are also presented for each synonym.…”