Traumatic brain injury during Operation Iraqi Freedom: findings from the United States Navy–Marine Corps Combat Trauma Registry

Michael R. Galarneau M.S. 1 , Susan I. Woodruff Ph.D. 2 , Judy L. Dye M.S., R.N., A.N.P. 2 , Charlene R. Mohrle M.S., R.N. 2 , and Amber L. Wade M.P.H. 2
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  • 1 Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center; and
  • 2 Health Research and Applied Technologies Division, Science Applications International Corporation, Inc., San Diego, California
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Object

The purpose of this study was to characterize traumatic brain injuries (TBIs) among military personnel (primarily Marines) during the second phase of Operation Iraqi Freedom from early in the medical care chain of evacuation through Landstuhl Regional Medical Center, a Level 4 American hospital in Germany.

Methods

Data were obtained from the Navy–Marine Corps Combat Trauma Registry (CTR) and included both battle and nonbattle injuries. Follow-up of patients with TBI was conducted to examine the short-term medical and personnel-related effects of TBI among those surviving.

Results

Those injured in battle were more likely than those not injured in battle to have multiple TBI diagnoses, a greater number of all diagnoses, more severe TBIs, and to be medically evacuated. Intracranial injuries (for example, concussions) were the predominant type of TBI, although skull fractures and open head wounds were also seen. Improvised explosive devices were the most common cause of TBIs among battle injuries; blunt trauma and motor vehicle crashes were the most common causes among nonbattle injuries. Short-term follow-up of surviving patients with TBI indicated higher morbidity and medical utilization among the patients with more severe TBI, although mental conditions were higher among patients with milder TBI.

Conclusions

Data from the Navy–Marine Corps CTR provide useful information about combatants' TBIs identified early in the combat casualty process. Results may improve clinical care for those affected and suggest strategies for primary prevention. The CTR staff plans to conduct additional follow-up studies of this group of patients with TBI.

Abbreviations used in this paper: AIS = Abbreviated Injury Scale; CHAMPS = Career History Archival Medical and Personnel System; CTR = Combat Trauma Registry; ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification; IED = improvised explosive device; ISS = Injury Severity Score; MTF = medical treatment facility; OIF2 = Operation Iraqi Freedom, second phase; PTSD = posttraumatic stress disorder; TBI = traumatic brain injury.

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Contributor Notes

Address correspondence to: Michael R. Galarneau, M.S., Naval Health Research Center, 140 Sylvester Road, San Diego, California 92106. email: michael.galarneau@med.navy.mil.
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