TBI Drops in Afghanistan, Doctors Look for Cause

U.S. forces in Afghanistan have suffered fewer traumatic brain injuries in Afghanistan in 2012 than in 2011. Records show that traumatic brain injuries among troops in Afghanistan have dropped from 645 per month in 2011 to 373 per month through the first 10 months of this year, according to the Armed Force Health Surveillance Center in Washington, DC.

The principal reason for the drop in TBI cases is certainly tied to the statistic that shows a reduction in the number of fatalities from improvised explosive devices. In 2012, 130 troops died from IED attacks compared to 252 last year and 368 in 2010, according to the website iCasualties.org, which tracks deaths by conflict and country.

The lower TBI numbers may also be due to the lower troop levels in Afghanistan, said Navy Cmdr. Kathleen Grudzien, chief of the surveillance office at the Defense and Veterans Brain Injury Center in Washington. The brain injury center is the TBI operational component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

However, she also suggested that the drop may also reflect a more aggressive approach to diagnosing and treating concussions before they turn into something more serious.

"There are so many factors in theater that need to be considered with regard to [the drop]," Grudzien said.  There is always "a lot of surmising when you're looking at the data," but brain center officials would like to think that one reason for the drop is the aggressive use of a tool for diagnosing concussions and Defense Department instructions mandating treatment.

The tool -- Military Acute Concussion Evaluation -- is actually a laminated card carried by medics and corpsmen, the first on the scene of any accident or combat. The medics use the card to pose a series of questions to anyone who may have suffered any kind of head trauma. They're looking for a troops' ability to remember things -- sequences of words or instructions -- and to see the kinds of word connections or associations they make when prompted.

Because troops generally don't like to be pulled away from their teams, the questions on the cards are regularly changed and not shared, lest soldiers try to beat the testing, according to Grudzien.

But even those who pass are required to take 24-hours rest, she said. If the unit is out in the field that mandatory rest period may be waived until return to base, but it is required. For those who show signs of concussion, Defense Department instructions require that the soldier be moved up the chain for whatever care health or medical officials determine may be necessary.

They're returned to the unit only after being medically cleared.

There have been 262,000 concussions experienced by soldiers between 2000 and October 2012, according to Pentagon records. About 76 percent of them were mild, she said, while the vast majority of the injured soldiers had recovered within seven to 10 days.

"We can't say definitely that [treatment] was the driver" to the numbers going down, she said, "But certainly, as we provide the tools and knowledge to [medical providers] in the field there is an opportunity for increased diagnoses, increased treatment. I think that's a good thing."