Systems Engineering to Improve Traumatic Brain Injury Care in the Military Health System Workshop Summary (2009) / Chapter Skim
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2 Medical Aspects of Traumatic Brain Injury--Robert Labutta
2 Medical Aspects of Traumatic Brain Injury--Robert Labutta
Pages 21-30
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From page 21... ...
Definition and Categorization of Traumatic brain injury The evolving definition of TBI, as currently used by the military, is shown in Box 2-1. Note that TBI involves both an injurious incident This chapter is based on the author's presentation and responses to questions raised during the plenary session of the NAE-IOM workshop on Harnessing Systems Engineering to Improve Traumatic Brain Injury Care in the Military Health System on June 11, 2008.
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From page 22... ...
The most common way to categorize non-penetrating TBI is by the severity of the injury -- mild, moderate, or severe. The level of severity is classically defined at the time of injury using measures of the state of consciousness (the Glasgow Coma Scale)
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From page 23... ...
In some clinical situations, however, the initial categorization of a TBI does not necessarily correspond to the eventual extent of neurological damage or the eventual outcome. For example, the initial injury may not be categorized as severe, but if there is subsequent significant brain swelling or bleeding in the head (intracerebrally, under the dura mater, or between the dura mater and the skull)
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From page 24... ...
Figure 2-1.eps personnel with TBI war wounds (by severity level) who were evacuated out of the combat theater to one of the DVBIC network sites between 2005 and 2007.
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From page 25... ...
In many cases, a large portion of the skull may be removed to relieve intracranial pressure and allow the brain to swell without causing additional damage. Brain injury resulting from primary and secondary effects may result in long-lasting symptoms and clinical manifestations affecting motor, sensory, mood, memory, and higher reasoning functions depending on the locus of the injury.
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From page 26... ...
. Post-deployment screening surveys indicate that 10 to 20 percent of military personnel report experiencing an mTBI during their deployment.
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From page 27... ...
Following acute critical care, these TBI patients require both acute and chronic rehabilitative care. Rehabilitation often takes many months and involves a variety of specialty teams, such as physical therapists, occupational therapists, hearing and vision specialists, mental health workers, social workers, and other specialists.
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From page 28... ...
However, care in combat situations must be based on preparing seriously injured patients to be quickly evacuated from the combat zone and preparing less seriously injured patients to return to duty so the military mission can be accomplished. These requirements and the need to employ all able military personnel make the environment of care different for military personnel than for civilians.
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From page 29... ...
. Presentation at the Workshop on Harnessing Operational Systems Engineering to Improve Traumatic Brain Injury Care in the Military Health System, National Academies, Washington, D.C.
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