Jaffee Michael S, Helmick Kathy M, Girard Philip D, Meyer Kim S, Dinegar Kathy, George Karyn
Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center (WRAMC), Washington, DC, USA.
J Rehabil Res Dev. 2009;46(6):655-66. doi: 10.1682/jrrd.2008.09.0114.
The nature of current combat situations that U.S. military forces encounter and the use of unconventional weaponry have dramatically increased service personnel's risks of sustaining a traumatic brain injury (TBI). Although the true incidence and prevalence of combat-related TBI are unknown, service personnel returning from deployment have reported rates of concussion between 10% and 20%. The Department of Defense has recently released statistics on TBI dating back to before the wars in Iraq and Afghanistan to better elucidate the impact and burden of TBI on America's warriors and veterans. Patients with severe TBI move through a well-established trauma system of care, beginning with triage of initial injury by first-responders in the war zone to acute care to rehabilitation and then returning home and to the community. Mild and moderate TBIs may pose different clinical challenges, especially when initially undetected or if treatment is delayed because more serious injuries are present. To ensure identification and prompt treatment of mild and moderate TBI, the U.S. Congress has mandated that military and Department of Veterans Affairs hospitals screen all service personnel returning from combat. Military health professionals must evaluate them for concussion and then treat the physical, emotional, and cognitive problems that may surface. A new approach to health management and care coordination is needed that will allow medical transitions between networks of care to become more centralized and allow for optimal recovery at all severity levels. This article summarizes the care systems available for the acute management of TBI from point of injury to stateside military treatment facilities. We describe TBI assessment, treatment, and overall coordination of care, including innovative clinical initiatives now used.
美国军队所面临的当前战斗形势的性质以及非常规武器的使用，极大地增加了服役人员遭受创伤性脑损伤（TBI）的风险。尽管与战斗相关的TBI的真实发病率和患病率尚不清楚，但从部署地区返回的服役人员报告的脑震荡发生率在10%至20%之间。美国国防部最近公布了可追溯到伊拉克和阿富汗战争之前的TBI统计数据，以更好地阐明TBI对美国军人和退伍军人的影响及负担。重度TBI患者会经历一套完善的创伤护理体系，从战区急救人员对初始损伤的分诊，到急性护理、康复，然后返回家园和社区。轻度和中度TBI可能带来不同的临床挑战，尤其是在最初未被发现或因存在更严重损伤而治疗延迟的情况下。为确保对轻度和中度TBI进行识别和及时治疗，美国国会已授权军事医院和退伍军人事务部医院对所有从战斗地区返回的服役人员进行筛查。军事卫生专业人员必须对他们进行脑震荡评估，然后治疗可能出现的身体、情绪和认知问题。需要一种新的健康管理和护理协调方法，使不同护理网络之间的医疗过渡更加集中，并在所有严重程度级别上实现最佳康复。本文总结了从受伤点到美国本土军事治疗机构的TBI急性管理可用的护理系统。我们描述了TBI的评估、治疗以及整体护理协调，包括目前使用的创新临床举措。
