Creation of an Expanded Barell Matrix to Identify Traumatic Brain Injuries of U.S. Military Members

Abstract

This paper describes the creation of a new traumatic brain injury (TBI) classification system, the Barell+ system, derived by the Center for Army Medical Department Strategic Studies. The Barell+ system is an expansion of the standard international Barell body region by nature of injury diagnosis matrix developed by the International Collaborative Effort on Injury Statistics. The expanded version (Barell+) was created as a result of a mapping effort between the original Barell matrix and the Department of Defense severity classification system used for surveillance by the Defense and Veterans Brain Injury Center (DVBIC). Starting with the Barell TBI category definitions, 19 additional TBI-related diagnosis codes from the DVBIC classification were mapped into the resulting Barell+ matrix. The new Barell+ system is compared with the original Barell matrix and the DVBIC classification system. We recommend using the TBI frequency distributions created by the Barell+ system as input data in U.S. military medical modeling and simulation efforts because it better reflects the actual distribution of TBI injuries.