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Updated: Feb 5, 2026
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Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
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Acute neurological issues in the austere/military environment
Samuel A Woodle1, Ross C Puffer
1Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Current Opinion in Critical Care
|February 3, 2026
Summary
Advances in diagnostic tools like pupillometry and ultrasound enhance traumatic brain injury (TBI) care in austere, resource-limited settings. These technologies aid critical care providers in diagnosing TBI and initiating life-saving interventions before higher-level care is available.
Area of Science:
- Emergency Medicine
- Neurosurgery
- Critical Care
Background:
- Traumatic brain injury (TBI) care is primarily managed in resource-constrained, far-forward environments.
- Tertiary care facilities have advanced TBI care, but this does not reflect the global reality of initial TBI management.
Purpose of the Study:
- To review advancements in TBI diagnosis and management in austere environments.
- To highlight the potential for improved outcomes despite resource limitations.
Main Methods:
- Review of current literature on diagnostic adjuncts for TBI.
- Focus on technologies applicable in austere settings without CT scans.
Main Results:
- Quantitative pupillometry, near-infrared spectroscopy, optic nerve sheath ultrasound, and transcranial doppler ultrasound offer enhanced diagnostic capabilities.
- These tools help overcome the challenge of diagnosing TBI lesions without CT scans in austere settings.
- Adjunct diagnostics enable targeted interventions and improved TBI care.
Conclusions:
- Despite challenges, diagnostic aids and interventions are feasible for severe TBI in austere environments.
- Critical care providers can diagnose pathophysiology and provide life-saving care in austere settings.
- Overcoming treatment nihilism requires leveraging available technology for improved TBI patient outcomes.
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