Page 26 - JSOM Summer 2024

Incidence of Traumatic Brain Injuries
within the Prehospital Trauma Registry System

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Stephen M. Braden, MD ; Brit J. Long, MD ; Julie A. Rizzo, MD ;
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Michael D. April, MD, DPhil, MSc ; Bradley A. Dengler, MD ; Steven G. Schauer, DO, MS *
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ABSTRACT
Background: Traumatic brain injury (TBI) is often under- under 44 years. The most common causes of TBI in the civil-
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reported or undetected in prehospital civilian and military ian population include falls (28%), motor vehicle collisions
settings. This study evaluated the incidence of TBI within the (MVCs; 20%), and collisions with objects (19%). In contrast,
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Prehospital Trauma Registry (PHTR) system. Methods: We re- most military TBIs are caused by improvised explosive devices
viewed PHTR and the linked Department of Defense Trauma (IEDs). Current data obtained from recent military conflicts
Registry (DoDTR) records of casualties from January 2003 demonstrate varying practices regarding initial evaluation and
through May 2019 for diagnostic data and surgical reports. subsequent follow-up of TBI patients.
Results: A total of 709 casualties met inclusion criteria. The
most common mechanism was blast, including 328 (51%) in Role 1 facilities provide basic medical care, advanced first aid,
the non-TBI and 45 (63%) in the TBI cohorts. The median initial resuscitation, triage, and stabilization of patients. Se-
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injury severity scores in the non-TBI and TBI cohorts were 5 vere and sometimes moderate TBIs have clear symptomatic
and 14, respectively. The survival scores in the non-TBI and signs, while mild TBI may not display overt symptoms. Role 1
TBI cohorts were 98% and 92%, respectively. Subdural hema- providers typically assess TBI severity based on patients’ his-
tomas, followed by subarachnoid hemorrhages were the most tory, physical examination, and Glasgow Coma Scale (GCS).
common classifiable brain injuries. Other nonspecific TBIs oc- Grading scales once adopted by the Department of Defense
curred in 85% of the TBI cohort casualties. Seventy-two cases (DoD) categorized TBIs as mild, moderate, and severe based
(10%) were documented by the Role 1 clinician. Based on cod- on loss of consciousness, post-traumatic amnesia, GCS, altered
ing or operative data, 15 of the 72 (21%) were identified as consciousness, and neuroimaging findings. Early detection is
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TBIs. Of the 637 cases, which could not be decided based on crucial for optimal evaluation, initiation of therapy, impact on
coding or operative data, TBI was suspected in 42 (7%) cases long-term outcomes, and prevention of secondary injury.
based on Role 1 records. Conclusions: Over 1 in 10 casualties
presenting to a Role 1 facility had a TBI requiring transfer Casualty data from OIF and OEF are primarily collected by the
to a higher level of care. Our findings suggest the need for Joint Trauma System (JTS) DoD Trauma Registry (DoDTR),
improved diagnostic technologies and documentation systems which was specifically developed to aid performance improve-
at Role 1 facilities for accurate TBI diagnosis and reporting. ment. The Prehospital Trauma Registry (PHTR) module of the
DoDTR was developed to evaluate patients admitted to Role
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Keywords: prehospital; trauma; brain injury; concussion; head 1 facilities. The PHTR was composed of prehospital data
injury collected since 2013 using Tactical Combat Casualty Care
(TCCC) cards, TCCC after-action reports (AARs), and JTS
Trauma Resuscitation Records. This study presents data on
the incidence of TBI among patients transferred from a Role 1
Introduction
facility.
Traumatic brain injury (TBI) is triggered by exposure to an
external force that results in structural injury or disruption of Methods
normal brain function. The incidence of TBI among Service-
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members in Operation Enduring Freedom (OEF) and Opera- Data Acquisition
tion Iraqi Freedom (OIF) was significantly higher than other This is a secondary analysis of a previously described data set.
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injuries. TBIs are also common in the civilian population. Due to constraints associated with de-identified data at the
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Of the 2.5 million civilian patients who sustain a TBI annu- time of data set acquisition, only the age range was acquired
ally, 50,000 die and 80,000 remain disabled, making TBI the for each patient. The outcomes in this study were based on
leading cause of death and disability among individuals aged casualties linked to the DoDTR. Deterministic linkage was
*Correspondence to steven.g.schauer.mil@army.mil
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1 Capt Stephen M. Braden is affiliated with Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX. Maj Brit J. Long is an asso-
ciate professor in in the Department of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences, Bethesda,
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MD, and an associate professor at Brooke Army Medical Center, San Antonio, TX. LTC Julie A. Rizzo is a trauma surgeon in the Department
of Surgery at Brooke Army Medical Center, San Antonio, TX and is affiliated with the Uniformed Services University of the Health Sciences,
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Bethesda, MD. LTC Michael D. April is an Associate Professor in the Department of Military and Emergency Medicine at the Uniformed Ser-
vices University of the Health Sciences, Bethesda, MD, and is associated with the Center for Combat and Battlefield (COMBAT) Research at the
University of Colorado School of Medicine, Aurora, CO. LTC Bradley A. Dengler is affiliated with Military Traumatic Brain Injury Initiative in
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Bethesda, MD. LTC Steven G. Schauer is an Associate Professor within the Department of Military and Emergency Medicine at the Uniformed
Services University of the Health Sciences, Bethesda Maryland, is an emergency medicine physician and fellow in anesthesia critical care medicine
with Departments of Anesthesiology and Emergency Medicine at the University of Colorado School of Medicine, and research fellow with the
Center for Combat and Battlefield Research (COMBAT) at the University of Colorado School of Medicine, Aurora, CO.
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