The consequences of traumatic brain injury (TBI) sustained by soldiers in the battlefield are explored in an Editorial in this week's edition of The Lancet.
Whilst applauding greatly improved trauma care in battle, the Editorial says: "Survival rates have greatly increased, but an acceptable quality of life might be an entirely different matter. TBI and its sequelae are increasingly common in soldiers returning from Afghanistan and Iraq, which poses serious challenges for medicine and society."
A recent USA Today estimate put the number of US troops who may have signs of TBI at 20000 -- some five times greater than Pentagon official estimates. And with over half of all combat injuries due to explosive devices, the proportion of all injured soldiers with TBI has increased to 60%, from 14-20% in previous US war estimates. Rocket-propelled grenades, landmines, and other explosives are the cause of this.
The Editorial looks at the problems with diagnosis of TBI - which are not unique to the military - and the difficulties with the science behind the condition. Changes in atmospheric pressure following an explosives blast cause part of the primary blast injury; but the effects other types of energy -- electromagnetic, acoustical, and thermal -- need further investigation. The difficulties of distinguishing TBI from post-traumatic stress disorder, which shares many of the same symptoms, are also discussed. How does one screen for TBI -- formal neurological examination, or through questionnaires?
The Editorial says: "With its mechanisms murky, diagnosis tricky, incidence under-reported, treatment uncertain, and personal, societal, and economic tolls enormous, TBI is a clear crisis for the US military." The US Department of Defense is pouring millions into TBI research and has just established a Defense Center of Excellence for Psychological Health and Traumatic Brain Injury. But it is not just soldiers who need TBI treatment -- the war veterans join an estimated 1.4 million US civilian cases of TBI each year, caused through trauma such as falls, road accidents, hitting, or being hit by an object, and assaults. In the USA alone, around 5.3 million people are disabled as a result of TBI -- these statistics are not trivial.
It concludes: "In view of the costs of the wars in Afghanistan and Iraq, putting resources into research on the health consequences for military personal is not only the pragmatic thing to do, but also, according to all available scientific and medical evidence, urgently needed. The results of such research will benefit soldiers and civilians alike."
View the editorial associated with this press release by clicking on the link below:
http://multimedia.thelancet.com/pdf/press/USarmy.pdf
Journal
The Lancet