Le Tuan D, Gurney Jennifer M, Singh Karan P, Nessen Shawn C, Schneider Andrea L C, Agimi Yll, Bebarta Vikhyat S, Herson Paco S, Stout Katharine C, Cardin Sylvain, Crowder Alicia T, Ling Geoffrey S F, Stackle Mark E, Pusateri Anthony E
U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas; Department of Epidemiology and Biostatistics, UT Tyler School of Medicine, The University of Texas at Tyler Health Science Center, Tyler, Texas.
U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas; Joint Trauma System, Fort Sam Houston, Texas.
Am J Prev Med. 2023 Aug;65(2):230-238. doi: 10.1016/j.amepre.2023.01.043. Epub 2023 Mar 2.
Traumatic brain injury (TBI) is a major health issue for service members deployed and is more common in recent conflicts; however, a thorough understanding of risk factors and trends is not well described. This study aims to characterize the epidemiology of TBI in U.S. service members and the potential impacts of changes in policy, care, equipment, and tactics over the 15 years studied.
Retrospective analysis of U.S. Department of Defense Trauma Registry data (2002-2016) was performed on service members treated for TBI at Role 3 medical treatment facilities in Iraq and Afghanistan. Risk factors and trends in TBI were examined in 2021 using Joinpoint regression and logistic regression.
Nearly one third of 29,735 injured service members (32.4%) reaching Role 3 medical treatment facilities had TBI. The majority sustained mild (75.8%), followed by moderate (11.6%) and severe (10.6%) TBI. TBI proportion was higher in males than in females (32.6% vs 25.3%; p<0.001), in Afghanistan than in Iraq (43.8% vs 25.5%; p<0.001), and in battle than in nonbattle (38.6% vs 21.9%; p<0.001). Patients with moderate or severe TBI were more likely to have polytrauma (p<0.001). TBI proportion increased over time, primarily in mild TBI (p=0.02), slightly in moderate TBI (p=0.04), and most rapidly between 2005 and 2011, with a 2.48% annual increase.
One third of injured service members at Role 3 medical treatment facilities experienced TBI. Findings suggest that additional preventive measures may decrease TBI frequency and severity. Clinical guidelines for field management of mild TBI may reduce the burden on evacuation and hospital systems. Additional capabilities may be needed for military field hospitals.
创伤性脑损伤（TBI）是部署的军人面临的一个主要健康问题，在最近的冲突中更为常见；然而，对风险因素和趋势的全面了解尚未得到充分描述。本研究旨在描述美国军人创伤性脑损伤的流行病学特征，以及在研究的15年中政策、护理、设备和战术变化的潜在影响。
对在伊拉克和阿富汗的第3级医疗设施接受创伤性脑损伤治疗的军人进行了美国国防部创伤登记数据（2002 - 2016年）的回顾性分析。2021年使用Joinpoint回归和逻辑回归研究了创伤性脑损伤的风险因素和趋势。
在抵达第3级医疗设施的29735名受伤军人中，近三分之一（32.4%）患有创伤性脑损伤。大多数为轻度（75.8%），其次是中度（11.6%）和重度（10.6%）创伤性脑损伤。男性的创伤性脑损伤比例高于女性（32.6%对25.3%；p<0.001），在阿富汗高于伊拉克（43.8%对25.5%；p<0.001），在战斗中高于非战斗中（38.6%对21.9%；p<0.001）。中度或重度创伤性脑损伤患者更有可能发生多发伤（p<0.001）。创伤性脑损伤比例随时间增加，主要是轻度创伤性脑损伤（p = 0.02），中度创伤性脑损伤略有增加（p = 0.04），在2005年至2011年期间增加最快，年增长率为2.48%。
在第3级医疗设施的受伤军人中，三分之一经历了创伤性脑损伤。研究结果表明，额外的预防措施可能会降低创伤性脑损伤的频率和严重程度。轻度创伤性脑损伤现场管理的临床指南可能会减轻后送和医院系统的负担。军事野战医院可能需要额外的能力。
