Back to Top Skip to main content

Identification of brain injuries in deployed environment surged after enactment of DoD policies

Recommended Content:

Traumatic Brain Injury

SILVER SPRING, Md. — Between 2006 and 2013, policies developed and implemented by the Department of Defense to encourage reporting of theater sustained brain injuries more than doubled the number of identified traumatic brain injuries (TBIs) in the U.S. military, according to a new study by researchers at the Defense and Veterans Brain Injury Center (DVBIC). This study is the first comprehensive analysis of the role of Defense Department and service-specific policies on identification of deployment-related TBI.

The results, reported in today’s issue of the American Journal of Public Health, point to a number of Army Messages (ALARACTs) and Department of Defense Instructions that effectively curbed underreporting and underdiagnoses of theater-sustained concussions. 

“More than 2.6 million service members were deployed to Afghanistan and Iraq, where TBI, primarily caused by blast, was underreported and underdiagnosed” said lead author Yll Agimi, a contract health data scientist at DVBIC. “Even in the challenging theater environment, Department of Defense and service-specific efforts showed considerable success in tackling this longstanding problem.”

The Defense Department was criticized for not doing enough to identify brain injuries among deployed service members. “The Defense Department responded by enacting specific requirements that led to a significant increase in the identification and treatment of service members with combat sustained TBIs that may have been missed otherwise,” said Donald Marion, a contract senior neurosurgeon with DVBIC and co-author of the study.  

Agimi and colleagues compared the number of TBIs before and after introduction of new policies aimed at screening for and identifying deployment-related TBIs. Two Army policies were especially impactful. ALARACT 143/2006, which alerted Army commanders to concussions and to medically evaluate soldiers if they showed “red flags,” was associated with a nearly three-fold increase in identified TBIs. ALARACT 160/2007, which required TBI awareness training for all pre-deployment service members, was associated with another one-fold increase in the rate of reported TBIs. Among airmen, introduction of TBI screening questions on the Post Deployment Health Assessment was associated with a 78 percent increase in reported TBIs. The 2010 Defense Department’s Directive Type Memorandum (DTM 09-033), mandating medical evaluation of those within 50 meters of a blast, was associated with an 80 percent increase in identified TBIs among soldiers, a 51 percent increase among sailors, and a 124 percent increase among Marines. These findings held even after the researchers accounted for other factors that could influence higher TBI rates, ranging from higher combat intensity and improved medical technologies in theater to better TBI documentation across the Military Health System.

Importantly, the study found that development of new TBI identification and treatment policies may not have the intended impact unless there is adequate and effective DoD-wide communication of the policy. “A key finding of this study is the importance of disseminating a new policy to all service members,” said Katherine Helmick, DVBIC acting director, also a co-author on the study. “These policies worked because the Defense Department and the services got the word out about them. However, more work remains to be done. It is very important that these findings spur further study to determine the best approach to ensure all service members with brain injuries are identified and treated.”

Ultimately, the identification of more TBIs should lead to better outcomes. “Early detection of brain injury affords the opportunity for the earliest treatment, which promotes best outcomes,” said Helmick. “And we have a commitment to our service members to get them treated in the best way possible and to those whom they defend to ensure a medically ready force.”

The study, entitled “Role of Department of Defense policies on traumatic brain injury identification and reporting among deployed US service members (2001-2016)”appears in the March 22 issue of the American Journal of Public Health. The Defense and Veterans Brain Injury Center, a center of excellence with the Defense Health Agency, supported this work.

You also may be interested in...

Positive attitude, social support may promote TBI/PTSD resilience

Article
7/23/2019
Navy Lt. Cmdr. John Derenne, a psychiatrist at Naval Hospital Jacksonville, discusses mental health and resiliency at the hospital’s Behavioral Health Clinic. Derenne, a native of Orange, California, says, “Mental health challenges should not be hidden or ignored; seeking help early is a sign of strength. Just like physical fitness, good mental health is integral to your well-being and mission readiness.” (U.S. Navy photo by Jacob Sippel)

Psychological experiences prior to an injury may play a role in recovery

Recommended Content:

Posttraumatic Stress Disorder | Traumatic Brain Injury

Warm Handoff for Transitioning Servicemembers Suffering from PTSD and TBI

Congressional Testimony
7/8/2019

S. 2987, SASC Report for FY 2019, 115-262, Pg. 203-204

Recommended Content:

Posttraumatic Stress Disorder | Traumatic Brain Injury

New clinical recommendations on cognitive rehabilitation for TBI released

Article
6/24/2019
Dr. Gregory Johnson (right), Tripler Concussion Clinic medical director, has Army Spc. Andrew Karamatic, Department of Medicine combat medic, follow his finger with his eyes during a neurologic exam at Tripler Army Medical Center, Honolulu. (U.S. Air Force photo by Staff Sgt. Christopher Hubenthal)

Cognitive rehabilitation focuses on improving thinking and communication skills

Recommended Content:

Mental Health Care | Traumatic Brain Injury | Mental Wellness

Chronic Traumatic Encephalopathy (CTE)

Congressional Testimony
6/13/2019

H.R. 5515 HASC Report for FY 2019 115-676, Pg. 128

Recommended Content:

Traumatic Brain Injury

Medical museum features mask-making arts therapy exhibit

Article
4/5/2019
Masks made by patients at the National Intrepid Center of Excellence at Walter Reed National Military Medical Center are seen on display at the National Museum of Health and Medicine, a division of the Defense Health Agency Research and Development Directorate, in an exhibit titled "Visual Voices of the Invisible Wounds of War." The exhibit is on display through May 31, 2019. (Department of Defense photo by Matthew Breitbart)

The exhibit explores the psychosocial environment of patients with TBI

Recommended Content:

Traumatic Brain Injury | National Museum of Health and Medicine

Emerging technology improves ability to see ‘invisible’ wounds

Article
3/29/2019
As well as providing high-resolution clinical imaging capabilities, the 3T Magnetic Resonance Imaging (MRI) scanner used at the NICoE provides researchers access to cutting-edge image acquisition methods, such as multiband diffusion tensor imaging (DTI) and echo planar imaging (EPI) sequences. (Photo courtesy of NICoE)

Ultimate goal is better understanding, quality of life for warfighters

Recommended Content:

Traumatic Brain Injury

The National Intrepid Center of Excellence promotes warfighter brain health during Brain Injury Awareness Month

Article
3/28/2019
U.S. Public Health Service Lt. Sherray Holland, education and outreach lead at the National Intrepid Center of Excellence, Walter Reed National Military Medical Center, participates in the 2019 Brain Injury Awareness Day event at Capitol Hill, in Washington, D.C. (Photo by NICoE Public Affairs)

For the fifth year, the NICoE hosted a TBI resource fair at Walter Reed National Military Medical Center

Recommended Content:

Traumatic Brain Injury

Traumatic brain injury: Stories of strength and resilience

Article
3/19/2019
Army Sgt. 1st Class Bradley Lee got help for traumatic brain injury and continues to serve. (DVBIC photo by Trent Watts)

Not everyone with a TBI experiences the same signs and symptoms

Recommended Content:

Traumatic Brain Injury

Defense and Veterans Brain Injury Center releases new concussion screening tool

Article
3/15/2019
Military health care providers practice administering the MACE 2 during a two-day TBI workshop led by DVBIC at Fort Belvoir, Virginia. (Photo by Carlson Gray)

Providers who screen patients for concussion now have a new and improved tool

Recommended Content:

Traumatic Brain Injury

Concussion: Know the Symptoms

Video
3/12/2019
Concussion: Know the Symptoms

A racquetball game goes wrong when one player slips and hits his head. He thinks he's OK and his partner isn’t sure what to do about it.

Recommended Content:

Traumatic Brain Injury

DoD recognizes Brain Injury Awareness month, promotes warfighter brain health

Article
3/1/2019
The Defense and Veterans Brain Injury Center is leveraging new technologies and cutting-edge research to develop concussion care tools and protocols that prioritize early identification and individualized treatment to maximize warfighter brain health. (MHS graphic)

Traumatic Brain Injury is a signature injury of current conflicts

Recommended Content:

Traumatic Brain Injury

Traumatic Brain Injury/Psychological Health

Congressional Testimony
1/25/2019

S. 3000, SAC Report for FY 2017, 114-263, Pg. 193

Recommended Content:

Traumatic Brain Injury | Mental Health Care

Promoting better understanding, treatment of traumatic brain injury

Article
12/26/2018
Marine Corps Staff Sgt. Anthony Mannino performs Art Therapy as part of his Traumatic Brain Injury (TBI) treatment and recovery. Art Therapy Interns, Adrienne Stamper (left) and Nancy Parfitt instruct and work with Mannino as he receives his art therapy. The therapy is conducted at the National Intrepid Center of Excellence, Walter Reed National Military Medical Center located in Bethesda, Maryland. (Department of Defense photo by Marvin Lynchard)

Blood test to identify TBI among 2018 achievements

Recommended Content:

Traumatic Brain Injury

Pilot Program on Investigational Treatment of Members of the Armed Forces for TBI and PTSD

Congressional Testimony
10/9/2018

HR 3304, NDAA for FY 2014, Sec. 704

Recommended Content:

Traumatic Brain Injury | Physical Disability | Mental Health Care | Posttraumatic Stress Disorder

Labyrinth: This path is made for mindful walking

Article
9/27/2018
Wounded warriors at the National Intrepid Center of Excellence are introduced to the indoor labyrinth during early days of their four-week intensive outpatient treatment program. (Photo courtesy of NICoE)

NICoE uses ancient symbol to promote healing

Recommended Content:

Warrior Care | Traumatic Brain Injury | Cognitive Rehabilitation Therapy
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 6

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing: Download a PDF Reader or learn more about PDFs.