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to the available data post-extraction by the registrars. Thus, 9. Robinson JB, Smith MP, Gross KR, et al. Battlefield documen-
we do not know the original source of the extracted data (e.g., tation of tactical combat casualty care in Afghanistan. US Army
TCCC card vs. TCCC AAR form vs. MACE card, etc.). While Med Dep J. 2016;(2–16):87–94.
unrelated to this study, the PHTR as a module of the DoDTR 10. Schauer SG, April MD, Naylor JF, et al. A descriptive analysis of
data from the Department of Defense Joint Trauma System Prehos-
does not exist anymore and will not include additional casu- pital Trauma Registry. US Army Med Dep J. 2017;(3–17):92–97.
alty data. Thus, the data presented here represents only limited 11. Carius BM, Dodge PM, Fisher AD, Loos PE, Thompson D,
data focused on the Role 1 setting. Further, TCCC cards have Schauer SG. An analysis of Prehospital Trauma Registry after-
been invaluable to Role 1 data collection; however, they were action reviews in Afghanistan. J Spec Oper Med. 2021;21(2):49–
not incorporated until substantially later in the conflicts and 53. doi:10.55460/1EOJ-0HRV
underwent multiple revisions, which likely affected the avail- 12. Khokhar B, Jorgensen-Wagers K, Marion D, Kiser S. Military
25
able data. Deployed performance improvement would benefit acute concussion evaluation: a report on clinical usability, utility,
and user’s perceived confidence. J Neurotrauma. 2021;38(2):210–
from real-time and prospective data collection. 26 217. doi:10.1089/neu.2020.7176
13. Le TD, Gurney JM, Singh KP, et al. Trends in Traumatic Brain
Injury Among U.S. Service Members Deployed in Iraq and Af-
Conclusion ghanistan, 2002-2016. Am J Prev Med. 2023;65(2):230–238.
In this study, over 1 in 10 casualties presenting to a Role 1 doi:10.1016/j.amepre.2023.01.043
facility had a TBI requiring transfer to a higher level of care. 14. Dengler BA, Agimi Y, Stout K, et al. Epidemiology, patterns of care
and outcomes of traumatic brain injury in deployed military settings:
Improvements in documentation from this setting are needed Implications for future military operations. J Trauma Acute Care
to enable TBI-specific performance improvement. Our find- Surg. 2022;93(2):220–228. doi:10.1097/TA.0000000000003497
ings suggest that improved diagnostic technologies are needed 15. Kotwal RS, Butler FK, Edgar EP, Shackelford SA, Bennett DR,
for Role 1 care. Bailey JA. Saving lives on the battlefield: a Joint Trauma System
review of pre-hospital trauma care in combined joint operating
Acknowledgments area? Afghanistan (CJOA-A) executive summary. J Spec Oper
Med. 2013;13(1):77–85.
The authors acknowledge the Department of Defense Trauma 16. Schauer SG, Naylor JF, Fisher AD, et al. An analysis of 13 years of
Registry (DoDTR) for providing data for this study. prehospital combat casualty care: implications for maintaining a
ready medical force. Prehosp Emerg Care. 2022;26(3):370–379.
Disclaimer doi:10.1080/10903127.2021.1907491
The views expressed in this article are those of the authors and 17. Glenn MA, Martin KD, Monzon D, et al. Implementation of a
do not reflect the official policy or position of the U.S. Army combat casualty trauma registry. J Trauma Nurs. 2008;15(4):181–
Medical Department, Department of the Army, Department of 184. doi:10.1097/01.JTN.0000343323.47463.aa
Defense, or the U.S. Government. 18. O’Connell KM, Littleton-Kearney MT, Bridges E, Bibb SC. Eval-
uating the Joint Theater Trauma Registry as a data source to
benchmark casualty care. Mil Med. 2012;177(5):546–552. doi:
Disclosures 10.7205/milmed-d-11-00422
BJL, JAR, MDA, BAD, and SGS have received funds from the 19. Korley FK, Datwyler SA, Jain S, et al. Comparison of GFAP and
Department of Defense in the form of grants to their institu- UCH-L1 measurements from two prototype assays: the Abbott
tion for unrelated work. We have no other conflicts to report. i-STAT and ARCHITECT assays. Neurotrauma Rep. 2021;2(1):
193–199. doi:10.1089/neur.2020.0037
References 20. Whiting MD, Dengler BA, Rodriguez CL, et al. Prehospital de-
1. Swanson TM, Isaacson BM, Cyborski CM, French LM, Tsao JW, tection of life-threatening intracranial pathology: an unmet need
Pasquina PF. Traumatic brain injury incidence, clinical overview, and for severe TBI in austere, rural, and remote areas. Front Neurol.
policies in the US military health system since 2000. Public Health 2020;11:599268. doi:10.3389/fneur.2020.599268
Rep. 2017;132(2):251–259. doi:10.1177/0033354916687748 21. Boulter JH, Shields MM, Meister MR, Murtha G, Curry BP, Den-
2. Terrio H, Brenner LA, Ivins BJ, et al. Traumatic brain injury gler BA. The expanding role of quantitative pupillometry in the
screening: preliminary findings in a US army brigade combat team. evaluation and management of traumatic brain injury. Front Neu-
J Head Trauma Rehabil. 2009;24(1):14–23. doi:10.1097/HTR. rol. 2021;12:685313. doi:10.3389/fneur.2021.685313
0b013e31819581d8 22. Warden D. Military TBI during the Iraq and Afghanistan wars.
3. Faul M, Wald MM, Xu L, Coronado VG. Traumatic brain injury Journal Head Trauma Rehabil. 2006;21(5):398–402. doi:10.1097/
in the United States: emergency department visits, hospitalizations, 00001199-200609000-00004
and deaths. National Center for Injury Prevention and Control 23. Schauer SG, Naylor JF, Long AN, et al. Analysis of injuries and
(U.S.). Division of Injury Response; 2010. prehospital interventions sustained by females in the Iraq and Af-
4. Centers for Disease Control and Prevention. Traumatic Brain In- ghanistan combat zones. Prehosp Emerg Care. 2019;23(5):700–
jury & Concussion. September 7, 2023. Accessed July 15, 2021. 707. doi:10.1080/10903127.2018.1560849
https://www.cdc.gov/traumaticbraininjury/index.html. 24. Howard JT, Kotwal RS, Stern CA, et al. Use of Combat Casu-
5. Fisher AD, April MD, Naylor JF, Kotwal RS, Schauer SG. The alty Care Data to Assess the US Military Trauma System During
Battalion Aid Station-The Forgotten Frontier of the Army Health the Afghanistan and Iraq Conflicts, 2001-2017. JAMA Surg.
System During the Global War on Terrorism. Mil Med. 2023;188 2019;154(7):600–608. doi:10.1001/jamasurg.2019.0151
(5–6):e1240–e1245. 25. Nissley LE, Rodriguez R, April MD, Schauer SG, Stevens GJ. Oc-
6. Management of Concussion/Mild Traumatic Brain Injury Working cam’s razor and prehospital documentation: when the simpler
Group.VA/DoD Clinical Practice Guideline for Management of solution resulted in better documentation. Med J (Ft Sam Houst
Concussion/Mild Traumatic Brain Injury. Department of Veterans Tex). 2023;(Per 23-1/2/3):81–86.
Affairs and Department of Defense; 2016. 26. Schauer SG, Mora AG, Maddry JK, Bebarta VS. Multicenter, pro-
7. Schauer SG, Naylor JF, April MD, Fisher AD, Bynum J, Kotwal RS. spective study of prehospital administration of analgesia in the
16 Years of Role 1 trauma care: a descriptive analysis of casualties U.S. combat theater of Afghanistan. Prehosp Emerg Care. 2017;
within the prehospital Trauma Registry. Med J (Ft Sam Houst Tex). 21(6):744–749. doi:10.1080/10903127.2017.1335814
2021;Pb 8-21-07/08/09:44–49.
8. Hobbs SS, Jasper LE. Detecting traumatic brain injury on the bat- PMID: 38865656; DOI: 10.55460/6RSJ-GXLF
tlefield. Combat & Casualty Care. Tactical Defense Media; 2021.

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