Traumatic Brain Injury in the Context of War: Introduction | Operational Definitions of TBI | Epidemiology | Mechanisms of Injury | Settings of Care | Screening | TBI Management in the Military | Return-to-Duty Criteria | Rehabilitation and Community Reentry | Future Directions and Clinical Research Opportunities | Key Clinical Points | Recommended Readings | References
Traumatic brain injury (TBI) is a common injury in
wartime. The notion that combat is a risk factor for TBI was recognized
long ago, as indicated by the fact that soldiers throughout the
world have been using helmets since ancient times. TBI is common
in war because, as Carey (1987) wrote, "the
head is preferentially exposed in combat as the soldier constantly
monitors his environment by means of exteroceptive neurosensory
structures (eyes, ears, and nose) in order to enhance his own survival" (p. 6).
Ballistics researchers estimate that the head and neck together
constitute 12% of the total body area that is exposed during
combat, and yet 15% to 25% of the wounds incurred during
combat in World War II, Korea, and Vietnam were to the head-neck
region (Carey 1987). The only body region with a higher proportion
of wounds in these wars was the extremities, which accounted for
53% to 55% of injuries (Carey 1987).