Chapter 26. Traumatic Brain Injury in the Context of War

Kimberly S. Meyer, M.S.N., C.N.R.N.; Brian Ivins, M.P.S.; Selina Doncevic, R.N., M.S.N.; Henry Lew, M.D., Ph.D.; Tina Trudel, Ph.D.; Michael S. Jaffee, M.D.
DOI: 10.1176/appi.books.9781585624201.683249



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).

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Figure 26–1. Post-Deployment Health Assessment (PDHA) Screening.Source. U.S. Department of Defense, DD Form 2796, January 2008.

Figure 26–2. Military Acute Concussion Evaluation (MACE).Source. Defense and Veterans Brain Injury Center, July 2007.

Figure 26–3. Brief Traumatic Brain Injury Screen (BTBIS).Source. Reprinted from Schwab KA, Ivins B, Cramer G, et al.: "Screening for Traumatic Brain Injury in Troops Returning From Deployment in Afghanistan and Iraq: Initial Investigation of the Usefulness of a Short Screening Tool for Traumatic Brain Injury." Journal of Head Trauma Rehabilitation 22(6): 377'€“389, 2007.

Figure 26–4. Deployed Setting Provider Algorithm.Source. Defense and Veterans Brain Injury Center.
Table Reference Number
Table 26–1. Veterans Affairs clinical reminder traumatic brain injury screen
Table Reference Number
Table 26–2. Department of Veterans Affairs (VA) polytrauma rehabilitation centers


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