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Traumatic Brain Injury Center of Excellence
The Defense Health Agency has developed a comprehensive clinical care program to manage concussions based on the military medical community’s many years of experience with injured service members.
Known as the Acute Concussion Care Pathway, the aim is to provide proactive care immediately after a potential head injury, followed by a standardized process for consistent care until a service member is able to return to duty.
“It’s no longer ‘come back if you're getting worse,’” Dr. Katharine Stout, assistant branch chief at the Traumatic Brain Injury Center of Excellence, said. “It's, ‘I need to see you back in 72 hours to make sure everything's going in the right direction.’”
The Acute Concussion Care Pathway evolved from years of research and data about patients with traumatic brain injury, or TBI. The TBICoE consolidated a vast array of information on acute concussion care into a singular pathway for effective care.
A key component of the program is based on an algorithm that optimizes patient care by evaluating a patient’s symptoms at different stages of care.
For medical providers, the pathway provides a suite of updated tools to evaluate a patient’s progress, and offers clear steps for service members to return to duty.
“This is really about performance and not so much about diagnosis,” Navy Capt. (Dr.) Scott Cota, the TBICoE’s branch chief, said. “It's more a performance-based tool and a performance-based process to return individuals to duty through a monitored system.”
The First Test
Diagnosis and the initial phase of care can start moments after a concussive event occurs. That could be exposure to a blast or explosion, a vehicle accident, or a sports injury.
Health care providers in the field can use a screening tool called the Military Acute Concussion Evaluation, or MACE 2, to identify symptoms and diagnose a potential concussion.
The MACE 2 is a standardized and comprehensive test of brain functions—cognitive, neurological, visual, hearing, balance, and memory. It’s most effective when administered as soon as possible after an injury.
An early MACE 2 evaluation can reveal critical information that will inform future treatment and improve the likelihood of an effective recovery.
“We know that early implementation can identify small deficits that could become bigger problems with time, affecting work, family life, and personal satisfaction,” Navy Capt. Duneley Rochino, lead of DHA’s neuromusculoskeletal clinical community, said. “Although it’s more common for patients to be evaluated in an emergency room, a medic or corpsman can perform the initial screening in a field environment, too.”