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Traumatic Brain Injury Resources for Medical Providers

TBICoE develops practical, easy-to-use clinical recommendations and tools to support health care providers in assessing and treating service members who have sustained a TBI. Clinical recommendations address common symptoms associated with mild TBI, such as headache, sleep disturbances, and vision problems. Most clinical recommendations have related patient resources to help educate patients through recovery.

Interested in learning more about the potential effects of low-level blast exposure? Discover which occupations and heavy weapon systems are associated with increased risk of LLB exposure and learn how to best document, manage, and care for your patients—to optimize warfighter brain health.

Need training on any of the clinical tools? Email us to schedule a training with our TBI educators, network dissemination specialists. Supplemental "Provider Education" materials are also available.

Acute Concussion Care Pathway

In order to standardize acute concussion assessment and care across the MHS, DHA established the Acute Concussion Care Pathway as part of the FY21 Quadruple Aim Performance Plan.

The goal of the ACC Pathway is to improve recovery times and outcomes by utilizing a multi-modal assessment tool at the time of injury—the Military Acute Concussion Evaluation 2—and to ensure timely access to repeat evaluations with personalized treatment protocols in alignment with a progressive return to activity process.

Supporting the goal of the ACC Pathway, the DHA Procedural Instruction 6490.04, titled “Required Clinical Tools and Procedures for Assessment and Clinical Management of Mild Traumatic Brain Injury/Concussion in Non-Deployed Setting,” establishes the required clinical tools and procedures for management of mild TBI, or concussion, in a non-deployed setting. Specifically, the use of the MACE 2 and a PRA framework for the assessment, management, and rehabilitation of all patients with a mild TBI.

The ACC Pathway—a standardized assessment and treatment plan for acute concussion, mandates:

  1. Use of the MACE 2 for acute assessment at the initial appointment 
  2. Follow-up within 72 hours after diagnosis of mild traumatic brain injury
  3. Completion of a progressive return to activity process prior to return to full duty

This fact sheet and educational video focus on standardizing the nomenclature for the ACC Pathway, delineating how each element intertwines to meet the objective of improving concussion outcomes across the MHS. 

 Thumbnail image of the downloadable fact sheet on the acute concussion care pathway. What is the Acute Concussion Care Pathway?

Download the ACC Pathway Fact Sheet

TBICoE offers a quarterly "Acute Concussion Care Pathway: MACE 2 & PRA" virtual training. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office.

The DOD published the DODI 6490.11, "DOD Policy Guidance for Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting" establishing policy, assigning responsibilities, and providing procedures on the management of mild TBI in the deployed setting.

TBICoE's MACE 2, PRA clinical recommendation, Recurrent Concussion Evaluation, and ICD-10 Coding Guidance for TBI support the ACC Pathway, the DHA-PI 6490.04, and the DODI 6490.11.

 

Military Acute Concussion Evaluation, Version 2

The 2018 MACE 2 is an acute assessment tool for all medically trained personnel who treat service members involved in a potentially concussive event. The clinical tool incorporates current state-of-the-science traumatic brain injury information, including vestibular-ocular-motor screening.

Download the MACE 2 and supporting materials.

 

Progressive Return to Activity

The 2021 Progressive Return to Activity: Primary Care for Acute Concussion Management clinical recommendation is an evidence-based return to activity protocol for primary care managers and concussion/TBI clinic providers.

Download the Progressive Return to Activity: Primary Care for Acute Concussion Management clinical recommendation and Patient and Leadership Guide.

Recurrent Concussion Evaluation

The Recurrent Concussion Evaluation is designed to guide providers in the management of patients with a history of three or more documented concussions within a 12-month span.

Clinical Recommendations and Support Tools for Mild Traumatic Brain Injury

TBICoE optimizes clinical care by combining evidence from medical literature, health care research, and expert opinion to develop and provide clinical recommendations and tools to help providers deliver evidence-based treatment and address the challenges associated with mild TBI.

  • Clinical recommendations provide guidance on assessing and managing mild TBI symptoms.
  • Clinical support tools offer an algorithmic approach to evaluating, managing, and referring mild TBI patients for specialty care.
  • Training material to show providers how to identify and treat patients with mild TBI-related symptoms.
  • Fact sheets and patient guides that provide tips and tools to help service members and veterans cope with a mild TBI.

UPDATED! Assessment and Management of Headache Following Concussion Clinical Suite

Thumbnail image of the downloadable assessment and management of headache following concussion clinical recommendation.This is a major revision of the 2016 clinical recommendation. Some key changes to new “Assessment and Management of Headache Following Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager” include:

  • Expansion of both non-pharmacologic and pharmacologic treatment of the most common types of post-traumatic headaches.
  • Inclusion of three additional post-traumatic headache subtypes—trigeminal, occipital neuralgia, and vestibular migraines, as well as increased focus on medication overuse headache.
  • Addition of considerations and precautions for preventive treatment options and treatment efficacy criteria to help primary care managers ensure optimal and effective treatment.

The revised patient education fact sheet on managing headache after concussion helps patients understand behavioral and pharmacological strategies their primary care manager may use to manage their PTH.

The all-new fact sheet on medication overuse headache should be reviewed with the patient, as it has space for clinicians to outline a treatment plan. It explains the basics of MOH, as well as treatment and prevention strategies.

 

Neuroendocrine Dysfunction Screening Following Concussion/Mild TBI

 

Neuroimaging Following Concussion/Mild TBI

 

Dizziness and Visual Disturbances Following Concussion/Mild Traumatic Brain Injury

 

Sleep Disturbances Following Concussion/Mild TBI

 

Cognitive Rehabilitation Following Mild to Moderate TBI

 

Neurocognitive Assessment Tool (NCAT) Testing Following Concussion/Mild TBI

 

Additional Clinical Support Tools

Check out the latest resource, "Medical Devices for Assessment of Traumatic Brain Injury." This fact sheet defines the different regulatory terms and pathways of medical devices, provides an overview on what devices are currently FDA approved for assessing TBI, and provides some considerations for clinicians and researchers before using a device.

Thumbnail image of the downloadable medical devices and TBI fact sheet.

Additional tools to assist in the identification, treatment, and management of patients with mild TBI in deployed and non-deployed settings are also available. Click below to download copies of the Glasgow Coma Scale, Epworth Sleepiness Scale, Insomnia Severity Index, Neurobehavioral Symptom Inventory, and a number of other evaluation tools.

Find and download the additional tools here.

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June 20, 2024, TBICoE QES Event: Left of the Boom

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Maintaining warfighter brain health is a top priority in the readiness and resiliency of service members. Join us for a discussion on optimizing brain health through reduction of risk and prevention of traumatic brain injury.

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TBICoE Research Review: Multiple TBI/Multiple Concussion

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Prior history of TBI may predispose an individual to increased risk of subsequent TBI, which may result from less force, and lengthier recovery from post-injury symptoms. Activities such as contact sports and military service carry particular risk for multiple TBI.

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Mar 5, 2024

Assessment and Management of Headache Following Concussion/ Mild TBI Clinical Recommendation

.PDF | 1.12 MB

This clinical recommendation, newly revised in 2024, includes specific recommendations of both pharmacologic and non-pharmacologic treatment of the most common types of post-traumatic headache, two additional PTH subtypes, and expanded information on medication overuse headache.

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Feb 23, 2024

Assessment and Management of Dizziness and Visual Disturbances Following Concussion/Mild Traumatic Brain Injury

.PDF | 1.03 MB

This clinical recommendation provides medical staff with a single, comprehensive reference for the assessment and management of dizziness and visual disturbances following mild TBI/concussion. Dizziness and visual disturbances often present with overlapping symptoms and should prompt a provider to perform a visual and dizziness—or vestibular—assessment.

Publication
Feb 23, 2024

Progressive Return to Activity: Primary Care for Acute Concussion Management

.PDF | 472.50 KB

This clinical recommendation is an evidence-based return to activity protocol for primary care managers and concussion/traumatic brain injury clinic providers. The PRA is a six-step approach that begins after the provider performs the MACE 2 (Military Acute Concussion Evaluation 2) and the patient is diagnosed with a concussion, also known as a mild TBI.

Publication
Dec 14, 2023

2024 TBICoE Quarterly Education Series Schedule

.PDF | 209.46 KB

Save the dates with a complete 2024 schedule of the Traumatic Brain Injury Center of Excellence's Quarterly Education Series. The QES is an enterprise-wide learning opportunity for Military Health System stakeholders. Since inception, the QES provides trainings and education events that are relevant to the MHS, discussing specialty topics and current ...

Publication
Dec 4, 2023

Acute Concussion Care Pathway: MACE 2 and PRA Training Flier

.PDF | 228.63 KB

The Traumatic Brain Injury Center of Excellence is hosting a combined Military Acute Concussion Evaluation and Progressive Return to Activity clinical recommendation virtual training. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office. Download the flier for the complete 2024 training schedule.

Publication
Nov 29, 2023

TBICoE's Low-Level Blast Research Efforts Infographic

.PDF | 2.12 MB

This infographic illustrates TBICoE's work to better understand how low-level blast influences warfighter brain health. These efforts directly support Line of Effort 2 of the Warfighter Brain Health Initiative.

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Sep 29, 2023

TBICoE Research Review: Mild TBI and PTSD

.PDF | 435.28 KB

This research review provides an in-depth summary of the available clinical research on the topic of co-morbid mild traumatic brain injury and posttraumatic stress disorder. Specifically, this review will address symptoms, anatomy, diagnosis, and treatment of mild TBI, PTSD, and the unique circumstances associated with the presentation of both.

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Mild TBI and PTSD Clinical Pearls

.PDF | 924.82 KB

TBICoE's "Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Clinical Pearls," is a new supplemental product to the detailed research review. This resource is designed to be brief and provide key actionable “clinical pearls” that should be considered in the treatment of service members with comorbid mild TBI and PTSD.

Last Updated: May 20, 2024
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