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Traumatic Brain Injury Classification Variability During the Afghanistan/Iraq Conflicts: Surveillance, Clinical,

Rachel Sayko Adams¹, Peter Hoover, Jeri E Forster

¹Institute 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).

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Summary

A refined traumatic brain injury (TBI) diagnosis code system revealed fewer cases than the standard Department of Defense definition. This highlights the need for improved TBI case ascertainment for better military healthcare and future conflict preparedness.

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Area of Science:

Military medicine
Neuroscience
Public health surveillance

Background:

Traumatic brain injuries (TBIs) pose significant challenges in military operations.
Accurate case ascertainment is crucial for understanding TBI prevalence and severity among service members.

Purpose of the Study:

To compare the prevalence and severity of TBI using a precise diagnosis code set versus the Department of Defense Standard Surveillance Case-Definition (DoD-Case-Definition).
To evaluate the impact of different TBI classification methods on military health data.

Main Methods:

A descriptive observational study analyzed TBI diagnoses in the Military Health System from 2001 to 2019.
Compared a precise TBI code set (excluding DoD-only and non-specific codes) against the DoD-Case-Definition.
Evaluated TBI frequencies and severity over time and against policy changes.

Main Results:

The DoD-Case-Definition identified a higher prevalence of TBIs, capturing over 164,000 individuals not identified by the precise code set.
A significant portion (73%) of cases identified solely by the DoD-Case-Definition used non-precise TBI codes, questioning diagnostic specificity.
The precise code set offered a more accurate representation of TBI diagnoses.

Conclusions:

The standard DoD TBI case definition may overestimate TBI prevalence due to the inclusion of non-specific codes.
Revisiting and standardizing TBI case ascertainment methods is essential for accurate surveillance and understanding long-term TBI effects.
Improved consensus on TBI classification will enhance preparedness for future conflicts and non-combat settings.