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Background
A traumatic brain injury (TBI) is defined as a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Conscussions, also called “closed head injuries”, are a type of TBI. Not all blows or jolts to the head result in a TBI. The severity of such an injury may range from “mild”, i.e., a brief change in mental status or consciousness to “severe”, i.e., an extended period of unconsciousness or amnesia after the injury. TBI can cause a wide range of functional changes affecting thinking, sensation, movement, language, and/or emotions. Some symptoms may appear immediately after the injury and other symptoms may not appear for days or weeks. Because of the nature of the injury and the symptoms, sometimes people may not recognize or admit that they have a problem. In post-concussion/mild TBI patients, recovery time is within weeks/months, but a small percentage have persistent symptoms. Patients with moderate to severe TBI may never fully recover their pre-injury function. The rate of combat-related brain injuries in servicemembers returning from the current conflicts in Iraq and Afghanistan appears to be highter than in previous conflicts. Nearly 30% of all patients with combat-related injuries seen at Walter Reed Army Medical Center from 2003 to 2005 sustained a TBI. Blast injuries are a significant cause of TBIs. TBI is often associated with severe multiple trauma, post traumatic stress disorder (PTSD) or undiagnosed concussions. Screening patients who are at risk for a TBI is important in order to ensure that TBIs are identifed and appropriately treated.
Table of Contents
Clinical Guidance
- Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), Fact Sheet Summarizing VA/DoD Evidence Based Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain Injury, 2009
- VA/DoD Management of Concussion/mild Traumatic Brain Injury Clinical Practice Guideline, Apr 09
- Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE),Tips for Treating Chronic Symptomatic Mild Traumatic Brain Injury and Post-Traumatic Stress Disorder
- American College of Emergency Physicians Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute Setting, Annals of Emergency Medicine Vol 52 No 6, Dec 08
- Defense and Veterans Brain Injury Center (DVBIC) Consensus Conference on the Acute Management of Concussion/Mild Traumatic Brain Injury (mTBI) in the Deployed Setting, August 08 (Updates DVBIC Acute Management of Mild Traumatic Brain Injury in Military Operational Settings Clinical Practice Guideline and Recommendations, Dec 06)
- Updated Mild Traumatic Brain Injury (mTBI) Clinical Guidance in Non-Deployed Medical Activities, May 08
- Coding Guidance for TBI Visits - Professional Services and Specialty Coding Guidelines Version 3.0 UBU 2008, 1 October 2008 paragraph 2.2.6.4
- Nursing Management of Adults with Severe Traumatic Brain Injury, American Association of Neuroscience Nurses (AANN) Clinical Practice Guideline Series, 2008
- DASD (FHP&R) Memo, Clinical Guidance for Mild Traumatic Brain Injury (mTBI) in Non-Deployed Medical Activities, 29 Oct 07
- Brain Trauma Foundation, TBI Treatment Guidelines
- Guidelines for the Management of Severe Traumatic Brain Injury, 3rd edition, 2007
- Guidelines for Prehospital Management of Traumatic Brain Injury, 2nd edition, 2007
- Guidelines for the Surgical Management of Traumatic Brain Injury, 2006
- Guidelines for Field Management of Combat-Related Head Trauma, 2005
- Guidelines for the Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children, and Adolescents, July 2003
- CDC, Heads Up: Brain Injury in Your Practice Tool Kit Jan 07
- CDC, Explosions and Blast Injuries: A Primer for Physicians
- Journal of the American Osteopathic Association Vol 106 No 5 May 2006, Mechanism-of-Injury Approach to Evaluating Patients with Blast-Related Polytrauma
- DVBIC List of Clinical Tools for Evaluation and Management of TBI
Policies and Directives
- DoD/Joint Forces
- HA Memorandum, Baseline Pre-deployment Neurocognitive Functional Assessment – Interim Guidance, 28 May 08
- DASD (FHP&R) Memo, Clinical Guidance for Mild Traumatic Brain Injury (mTBI) in Non-Deployed Medical Activities, 29 Oct 07
- HA Policy 07-030 Traumatic Brain Injury: Definition and Reporting, 1 Oct 07
- ASD(HA) Memorandum, Consolidation of Traumatic Brain Injury Initiatives in the Department of Defense, 23 Mar 07
- ASD(HA) Memorandum, Traumatic Brain Injury Questions for the Post-Deployment Health Assessment, 8 Mar 07.
- ASD(HA) Memorandum, Traumatic Brain Injury, 8 Mar 07.
- Multi-National Corps-Iraq (MNC-I) mTBI Policies
- Army
- Navy/Marines
- Veterans Administration
- Department of Veteran Affairs. 38 CFR Part 4, Schedule for Rating Disabilities: Evaluation of Residuals
of Traumatic Brain Injury (TBI). Federal Register, 73(2). Washington D.C., January 3, 2008,
Amendment (final): Federal Register 73(185), September 23, 2008: 54693-54708. (This document amends the Department of Veterans Affairs (VA) Schedule for Rating Disabilities by revising the portion of the Schedule that addresses neurological conditions and convulsive disorders. The effect of this action is to provide detailed and updated criteria for evaluating residuals of traumatic brain injury (TBI).)
- VHA Directive 2007-013, Screening and Evaluation of Possible Traumatic Brain Injury in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans, 13 Apr 07
- Veterans Health Administration, Under Secretary for Health's Information Letter (IL 10-2006-004), Screening and Clinical Management of Traumatic Brain Injury, 25 Jan 06
Fact Sheets
(DVBIC). The Instruction Brochure, Documentation Sheet, as well as Pocket Card and Wallet Card versions of the MACE are available to providers by contacting us at 1.800.870.9244 or info@dvbic.org.
Defense and Veterans Brain Inury Center (DVBIC) 3 Question TBI Screening Tool (To identify service members who may need further evaluation for mild traumatic brain injury (MTBI)).
VA Traumatic Brain Injury Disability Evaluation Worksheet
Brain Injury Association of America and Defense and Veterans Head Injury Program, A Guide to Selecting and Monitoring Brain Injury Rehabilitation Services
Education and Training
- Dot Mil Docs 48: Traumatic Brain Injury & Suicide Prevention, 3 Mar 09
(Webcast interview of Director, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury who discusses traumatic brain injury and suicide prevention.)
- Army Traumatic Brain Injury Program PowerPoint Briefing 25 Feb 09 - Prepared for Brain Injury Awareness Month by Army Proponency Office for Rehabilitation and Reintegration
- TRICARE Pilot Education Program for Civilian Providers on PTSD and TBI (Offers 17 Continuing Education Units. Direct care providers can take advantage of this CME educational opportunity through their existing MHS Learn accounts.)
- Army PTSD/mTBI Chain Teaching Program
- 2007 MHS Conference Presentation, Traumatic Brain Injuries: Pathophysiology, Treatment and Prevention
- Defense and Veterans Brain Injury Center (DVBIC) Documentary, Survive Thrive and Alive: Understanding Traumatic Brain Injury, 07
- Centre for Neuro Skills (CNS), CEU Course Mild Traumatic Brain Injury (MTBI): Identification, Assessment and Treatment
- National Database of Educational Resources on Traumatic Brain Injury
- Presentations from 2nd Federal TBI Interagency Conference, 9-11 Mar 06 including
- Incidence and Neuropsychiatric Sequelae of Traumatic Brain injury: Implications for the Military, PowerPoint Presentation to Armed Forces Epidemiological Board Meeting, 30 Nov 04
- VA, Veterans Health Initiative Independent Study Course, Traumatic Brain Injury, Jan 04
- eMedicine, Traumatic Brain Injury: Definition, Epidemiology, Pathophysiology
- MedlinePlus, Head and Brain Injuries
- Florida Institute for Neurologic Rehabilitation, Inc. Educational Booklets (Located on Resources Page)
- Understanding Brain Injury I Acute Hospitalization – A Guide for Family and Friends
- Understanding Brain Injury II Neurologic Rehabilitation – An Educational Guide
Research
- Special Issue of The Journal of Head Trauma Rehabilitation, Devoted to TBI in the Military, Vol 24 Issue 1, Jan/Feb 09
- Institute of Medicine, Gulf War and Health Reports Volume 7 Long-Term Consequences of Traumatic Brain Injury, 2009
- VA Office of Research and Development Program Announcement Traumatic Brain Injury, 17 Jun 08 (Seeking scientifically meritorious research proposals addressing issues concerning TBI. Research proposals may be submitted through FY 2012 for any of the regular merit review receipt dates as noted in this announcement.)
- Mild Traumatic Brain Injury in US Soldiers Returning from Iraq, Article in New England Journal of Medicine, Vol 358:453-463, 31 Jan 08
- Disentangling Mild Traumatic Brain Injury and Stress Reactions, Editorial in New England Journal of Medicine, Vol 358: 525-527, 31 Jan 08
- Traumatic Brain Injury National Data Center (The Traumatic Brain Injury National Data Center (TBINDC) at Kessler Medical Rehabilitation Research and Education Center is the coordinating center for the research and dissemination efforts of the Traumatic Brain Injury Model Systems (TBIMS) program funded by the National Institute on Disability and Rehabilitation Research (NIDRR). The TBI Model Systems consist of 16 comprehensive systems of care distributed throughout the United States that conduct innovative research and provide "model" care to persons who experience traumatic brain injury.)
- National Institute on Disability and Rehabilitation Research (NIDRR)
- Rehabilitation Research and Training Center (RRTC) on Community Integration of Persons with Traumatic Brain Injury (TBI), TBI Community Web Site (RRTC was awarded to researchers at TIRR (The Institute for Rehabilitation and Research) and Baylor College of Medicine by the National Institute on Disability and Rehabilitation Research (NIDRR). Its mission is to ensure that all those affected by TBI, including traditionally under-served populations, have access to information, resources, and services that maximize participation in their communities and that treating professionals have the necessary information to meet the needs of persons with TBI.)
- Defense and Veterans Brain Injury Center, Clinical Research
- VA Brain Rehabilitation Research Center
- Northeast Cognitive Rehabilitation Research Network (NCRRN)
- ClinicalTrials.gov, Traumatic Brain Injury Research (ClinicalTrials.gov provides regularly updated information about federally and privately supported clinical research in human volunteers.)
- Institute of Medicine Report, Evaluating the HRSA (Health Resources and Services Administration) Traumatic Brain Injury Program, 1 Mar 06
- Military Health System Publication Search Web Page (Click on Traumatic Brain Injury)
Related Links
- Federal
- National
- State
- Other
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