Current Management of Traumatic Brain Injury (TBI) May Lead to Subsequent Risk

Abstract

Background: Traumatic brain injuries (TBI) present military health providers with expanded clinical responsibilities. Such injuries can lead to lifelong consequences and have a remarkable impact on society and the economy. Between 2000 and 2016, more than 350,000 US active-duty military service members have sustained a TBI. A population-based historical cohort study revealed that medical care costs for persons with TBI were an average of $4906 higher than costs for matched controls without TBI. Method: We conducted a peer-reviewed literature review. The hypothesis that arose indicates that the polytraumatic nature of TBI injuries and the complexity of diagnosing and managing care. A secondary hypothesis was veterans with mild and greater TBI were not being surveilled for latent sequelae. Results: During the past decades, following US military deployments, long combat operations engagements and numerous deployments increase TBI injuries. More than 80% of TBIs in US service members are clinically classified as mild TBI (mTBI). Unlike severe TBIs, the management of individuals with mTBI is still symptom-based, and guidelines continue to highlight nonpharmacologic interventions, and surveillance relies on patients' self-reported symptoms. This may lead to a missed diagnosis, management, or treatment procedure and a public health crisis for mTBI. Conclusion: To minimize the adverse effects of the injury, the recognition of veterans who bear mTBI, and the timely application of treatment and surveillance plans are essential. If service members have an untreated concussion and return to duty, they will be more vulnerable to subsequent injury, and their performance capability in critical situations can be diminished. Furthermore, they may be at risk for secondary brain injury that arises hours or days after the primary injury due to the release of pro-inflammatory mediators and the death of neural cells, even though they appear to have recovered, which contribute to further damage.