Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Dr Adams); VA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado (Drs Adams, Forster, and Brenner); National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland (Mr Hoover and Dr Caban); and University of Colorado, Anschutz Medical Campus, Aurora (Drs Forster and Brenner).
J Head Trauma Rehabil. 2022;37(6):361-370. doi: 10.1097/HTR.0000000000000775. Epub 2022 Sep 5.
Challenges associated with case ascertainment of traumatic brain injuries (TBIs) sustained during the Afghanistan/Iraq military operations have been widespread. This study was designed to examine how the prevalence and severity of TBI among military members who served during the conflicts were impacted when a more precise classification of TBI diagnosis codes was compared with the Department of Defense Standard Surveillance Case-Definition (DoD-Case-Definition).
Identification of TBI diagnoses in the Department of Defense's Military Health System from October 7, 2001, until December 31, 2019.
Military members with a TBI diagnosis on an encounter record during the study window.
Descriptive observational study to evaluate the prevalence and severity of TBI with regard to each code set (ie, the DoD-Case-Definition and the more precise set of TBI diagnosis codes). The frequencies of index TBI severity were compared over time and further evaluated against policy changes.
The more precise TBI diagnosis code set excludes the following: (1) DoD-only extender codes, which are not used in other healthcare settings; and (2) nonprecise TBI codes, which include injuries that do not necessarily meet TBI diagnostic criteria.
When comparing the 2 TBI classifications, the DoD-Case-Definition captured a higher prevalence of TBIs; 38.5% were classified by the DoD-Case-Definition only (>164 000 military members). 73% of those identified by the DoD-Case-Definition only were diagnosed with nonprecise TBI codes only, with questionable specificity as to whether a TBI occurred.
We encourage the field to reflect on decisions made pertaining to TBI case ascertainment during the height of the conflicts. Efforts focused on achieving consensus regarding TBI case ascertainment are recommended. Doing so will allow the field to be better prepared for future conflicts, and improve surveillance, screening, and diagnosis in noncombat settings, as well as our ability to understand the long-term effects of TBI.
在阿富汗/伊拉克军事行动期间发生的创伤性脑损伤（TBI）病例确定方面存在诸多挑战。本研究旨在研究在将 TBI 诊断代码的更精确分类与国防部标准监测病例定义（DoD-Case-Definition）进行比较时，对参战军人的 TBI 患病率和严重程度的影响。
2001 年 10 月 7 日至 2019 年 12 月 31 日，在国防部医疗保健系统中识别 TBI 诊断。
研究期间就诊记录中有 TBI 诊断的军人。
描述性观察性研究，评估每个代码集（即 DoD-Case-Definition 和更精确的 TBI 诊断代码集）的 TBI 患病率和严重程度。随着时间的推移比较索引 TBI 严重程度的频率，并根据政策变化进行进一步评估。
更精确的 TBI 诊断代码集排除以下内容：（1）仅国防部扩展器代码，这些代码不在其他医疗保健环境中使用；（2）非精确的 TBI 代码，包括不一定符合 TBI 诊断标准的损伤。
在比较这两种 TBI 分类时，DoD-Case-Definition 捕获了更高的 TBI 患病率；仅 DoD-Case-Definition 分类的 TBI 患病率为 38.5%（超过 164000 名军人）。仅通过 DoD-Case-Definition 识别的人群中，有 73%被诊断为非精确 TBI 代码，特异性值得怀疑，即是否发生了 TBI。
我们鼓励该领域反思在冲突高峰期进行 TBI 病例确定所做的决策。建议集中精力就 TBI 病例确定达成共识。这样做将使该领域为未来的冲突做好更好的准备，并改善非战斗环境中的监测、筛查和诊断，以及我们对 TBI 长期影响的理解。
