Traumatic Brain Injury Recorded in the UK Joint Theatre Trauma Registry Among the UK Armed Forces

Abstract

To use the UK Joint Theatre Trauma Registry (UK-JTTR) to identify service personnel sustaining traumatic brain injury (TBI) in recent conflicts and to examine injury characteristics, outcomes, and severity measures predictive of survival. Operations HERRICK (Afghanistan) and TELIC (Iraq). The UK-JTTR records data for every UK service person either killed on operations or treated by Defence Medical Services after a trauma call, including those evacuated for inpatient care following traumatic injury. UK-JTTR data were retrospectively analyzed to identify those who sustained TBI. The Mayo system was used to define TBI. Glasgow Coma Scale score, injury severity score, new injury severity score, trauma injury severity score, abbreviated injury scale, and a severity characterization of trauma were used to predict survival. In total, 464 UK service personnel sustained TBI, representing 19% of the 2440 casualties in Afghanistan and Iraq, recorded in the UK-JTTR. Most TBI casualties had moderate-severe TBI (402, 87%). There were 181 (39%) survivors, 56% of these received neurorehabilitation. Improvised explosive devices accounted for 55% of TBIs sustained in Afghanistan and 31% of TBIs in Iraq. Logistic regression analyses were performed using the 412 cases (149 survivors: 263 fatalities) with scores on all severity measures. The best-fitting model was based on trauma injury severity score. A trauma injury severity score more than 11.13 indicates a more than 95% probability of survival. This is the first study of UK combat TBIs between 2003 and 2011. Almost 1 in 5 UK service personnel recorded in the UK-JTTR had TBI; most were moderate-severe. However, mild TBI is likely to be underrepresented in the UK-JTTR. These findings may be used to plan future rehabilitation needs, as almost half the survivors did not receive neurorehabilitation.