Robinson-Freeman Katherine E, Collins Kassondra L, Garber Bryan, Terblanche Ronel, Risling Marten, Vermetten Eric, Besemann Markus, Mistlin Alan, Tsao Jack W
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States.
Department of Physical Therapy, University of Saskatchewan, Saskatoon, SK, Canada.
Front Neurol. 2020 Aug 25;11:836. doi: 10.3389/fneur.2020.00836. eCollection 2020.
Mild traumatic brain injury (mTBI, also known as a concussion) as a consequence of battlefield blast exposure or blunt force trauma has been of increasing concern to militaries during recent conflicts. This concern is due to the frequency of exposure to improvised explosive devices for forces engaged in operations both in Iraq and Afghanistan coupled with the recognition that mTBI may go unreported or undetected. Blasts can lead to mTBI through a variety of mechanisms. Debate continues as to whether exposure to a primary blast wave alone is sufficient to create brain injury in humans, and if so, exactly how this occurs with an intact skull. Resources dedicated to research in this area have also varied substantially among contributing NATO countries. Most of the research has been conducted in the US, focused on addressing uncertainties in management practices. Development of objective diagnostic tests should be a top priority to facilitate both diagnosis and prognosis, thereby improving management. It is expected that blast exposure and blunt force trauma to the head will continue to be a potential source of injury during future conflicts. An improved understanding of the effects of blast exposure will better enable military medical providers to manage mTBI cases and develop optimal protective measures. Without the immediate pressures that come with a high operational tempo, the time is right to look back at lessons learned, make full use of available data, and modify mitigation strategies with both available evidence and new evidence as it comes to light. Toward that end, leveraging our cooperation with the civilian medical community is critical because the military experience over the past 10 years has led to a renewed interest in many similar issues pertaining to mTBI in the civilian world. Such cross-fertilization of knowledge will undoubtedly benefit all. This paper highlights similarities and differences in approach to mTBI patient care in NATO and partner countries and provides a summary of and lessons learned from a NATO lecture series on the topic of mTBI, demonstrating utility of having patients present their experiences to a medical audience, linking practical clinical care to policy approaches.
在最近的冲突中，战场爆炸暴露或钝器创伤导致的轻度创伤性脑损伤（mTBI，也称为脑震荡）越来越受到军队的关注。这种关注源于伊拉克和阿富汗执行任务的部队接触简易爆炸装置的频率，以及认识到mTBI可能未被报告或未被发现。爆炸可通过多种机制导致mTBI。关于仅暴露于一次冲击波是否足以在人类中造成脑损伤，以及如果是这样，在颅骨完整的情况下究竟是如何发生的，争论仍在继续。北约各参与国在该领域的研究资源也有很大差异。大多数研究是在美国进行的，重点是解决管理实践中的不确定性。开发客观的诊断测试应作为首要任务，以促进诊断和预后，从而改善管理。预计在未来冲突中，头部爆炸暴露和钝器创伤仍将是潜在的伤害来源。更好地了解爆炸暴露的影响将使军事医疗人员能够更好地处理mTBI病例并制定最佳防护措施。没有高行动节奏带来的紧迫压力，现在是回顾经验教训、充分利用现有数据并根据现有证据和新出现的证据修改缓解策略的时候了。为此，利用我们与民用医疗界的合作至关重要，因为过去10年的军事经验引发了对民用领域许多与mTBI相关的类似问题的新兴趣。这种知识的交叉融合无疑将使所有人受益。本文强调了北约国家和伙伴国家在mTBI患者护理方法上的异同，并总结了北约关于mTBI主题的一系列讲座的经验教训，展示了让患者向医疗受众讲述他们的经历、将实际临床护理与政策方法联系起来的效用。
