Farmer Carrie M, Krull Heather, Concannon Thomas W, Simmons Molly, Pillemer Francesca, Ruder Teague, Parker Andrew, Purohit Maulik P, Hiatt Liisa, Batorsky Benjamin Saul, Hepner Kimberly A
Rand Health Q. 2017 Jan 13;6(2):11. eCollection 2017 Jan.
Traumatic brain injury (TBI) is considered a signature injury of modern warfare, though TBIs can also result from training accidents, falls, sports, and motor vehicle accidents. Among service members diagnosed with a TBI, the majority of cases are mild TBIs (mTBIs), also known as concussions. Many of these service members receive care through the Military Health System, but the amount, type, and quality of care they receive has been largely unknown. A RAND study, the first to examine the mTBI care of a census of patients in the Military Health System, assessed the number and characteristics (including deployment history and history of TBI) of nondeployed, active-duty service members who received an mTBI diagnosis in 2012, the locations of their diagnoses and next health care visits, the types of care they received in the six months following their mTBI diagnosis, co-occurring conditions, and the duration of their treatment. While the majority of service members with mTBI recover quickly, the study further examined a subset of service members with mTBI who received care for longer than three months following their diagnosis. Diagnosing and treating mTBI can be especially challenging because of variations in symptoms and other factors. The research revealed inconsistencies in the diagnostic coding, as well as areas for improvement in coordinating care across providers and care settings. The results and recommendations provide a foundation to guide future clinical studies to improve the quality of care and subsequent outcomes for service members diagnosed with mTBI.
创伤性脑损伤（TBI）被认为是现代战争中的典型损伤，不过TBI也可能由训练事故、跌倒、运动和机动车事故导致。在被诊断为TBI的军人中，大多数病例为轻度TBI（mTBI），也称为脑震荡。这些军人中的许多人通过军事医疗系统接受治疗，但他们接受的治疗数量、类型和质量在很大程度上尚不清楚。兰德公司的一项研究首次对军事医疗系统中患者普查的mTBI治疗情况进行了调查，评估了2012年被诊断为mTBI的未部署现役军人的数量和特征（包括部署历史和TBI病史）、他们的诊断地点和下次医疗就诊地点、mTBI诊断后六个月内接受的治疗类型、并发疾病以及治疗持续时间。虽然大多数患有mTBI的军人恢复得很快，但该研究进一步考察了一部分诊断后接受治疗超过三个月的患有mTBI的军人。由于症状和其他因素的差异，诊断和治疗mTBI可能特别具有挑战性。研究发现诊断编码存在不一致之处，以及在跨提供者和护理环境协调护理方面有待改进的领域。研究结果和建议为指导未来的临床研究提供了基础，以提高对被诊断为mTBI的军人的护理质量和后续结果。
