Early traumatic brain injury screen in 6594 inpatient combat casualties

Introduction: The purpose of this study was to review the inpatient traumatic brain injury (TBI) screening program at a Role IV regional resource trauma center. TBI has been coined the "signature wound" during current U.S. combat operations. All patients injured in Iraq or Afghanistan who transit through Landstuhl Regional Medical Center (LRMC) undergo an initial TBI screen regardless of anatomic injury. The incidence and factors associated with positive screening for concussion (physical event + alteration of consciousness (AOC)) and TBI diagnoses were examined. Methods: A retrospective review of consecutively admitted patients to LRMC who underwent a TBI screen from 5/06 to 7/11 was performed. Patient characteristics, self-reported symptoms, and TBI diagnoses were analyzed. Findings: Among 43,852 patients screened during the 5-year period, 6594 were admitted, of whom, 6590 received a complete TBI screen. Predominantly male (97.1%), the mean age was 26.7 +/- 7.4 yrs. The average GCS and ISS at admission were 13.9 +/- 2.8 and 10.1 +/- 8.6, respectively. Positively screened patients averaged 1.8 deployments, 69.5% experienced one or more blasts, 16.1% experienced one or more vehicular crashes, with 18.0% reporting a prior head injury. Of the 2805 (42.6%) who screened positive for possible concussion, 2393 (85.3%) were diagnosed with a concussion/TBI during their inpatient stay; the remaining 412 (14.7%) were identified by screening only. Of the screened positive patients, 1953 (69.6%) reported 1 or more current concussion/TBI-related symptoms; of those with symptom(s), 532 (27.2%) reported 5 or more. Conclusions: Early screening based on self-report identified a large number of patients admitted directly from the combat zone with possible deployment-related concussion and TBI symptoms. Such screening provides valuable information to guide decisions about early management and return to duty. (C) 2016 Elsevier Ltd. All rights reserved.