Related Experiment Video
Updated: Aug 29, 2025
Author Spotlight: Developing Precise and Clinically Relevant Models for Studying Secondary Degeneration in Traumatic Optic Neuropathy
Published on: November 29, 2024
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).
Objective:
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).
Setting:
Identification of TBI diagnoses in the Department of Defense's Military Health System from October 7, 2001, until December 31, 2019.
Participants:
Military members with a TBI diagnosis on an encounter record during the study window.
Design:
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.
Main Measures:
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.
Results:
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.
Conclusion:
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.
More Related Videos
10:33Advanced Diffusion Imaging in The Hippocampus of Rats with Mild Traumatic Brain Injury
Published on: August 14, 2019
08:36Development of an Uncomplicated Mild Traumatic Brain Injury Model Modified by Weight-Drop Method and Evidenced by Magnetic Resonance Imaging
Published on: April 11, 2025
