Traumatic Brain Injury Classification Variability During the Afghanistan/Iraq Conflicts: Surveillance, Clinical, Research, and Policy Implications.
Traumatic Brain Injury Classification Variability During the Afghanistan/Iraq Conflicts: Surveillance, Clinical, Research, and Policy Implications.
复制标题
DOI：
10.1097/htr.0000000000000775
复制
发表时间：
2022-11-01
影响因子：
2.4
通讯作者：
Brenner, Lisa A.
中科院分区：
文献类型：
--
作者：
Adams, Rachel Sayko;Hoover, Peter;Forster, Jeri E.;Caban, Jesus;Brenner, Lisa A.
关键词：
与阿富汗/伊拉克军事行动期间持续的创伤性脑损伤（TBI）的病例确认相关的挑战一直很普遍。本研究的目的是研究如何在冲突期间服役的军人中TBI的患病率和严重程度受到影响时，使用更精确的分类TBI诊断代码相比，国防部标准监测病例定义。2001年10月7日至2019年12月31日国防部军事卫生系统中TBI诊断的识别。在研究窗口期间，在遭遇记录上诊断为TBI的军事成员。描述性观察性研究，以评价每个代码集的TBI患病率和严重程度（即，DoD-Case-Definition和更精确的TBI诊断代码集）。随着时间的推移，指数TBI严重程度的频率进行了比较，并根据政策变化进行了进一步评估。更精确的TBI诊断代码集不包括：1）DoD专用扩展代码，不用于其他医疗机构; 2）非精确的TBI代码，包括不一定符合TBI诊断标准的损伤。当比较两种TBI分类时，DoD病例定义捕获了更高的TBI患病率; 38.5%仅由DoD病例定义分类（> 164，000名军人）。仅通过DoD病例定义确定的患者中，73%仅诊断为非精确TBI代码，是否发生TBI的特异性值得怀疑。我们鼓励该领域反思在冲突高峰期间与TBI案件确认有关的决定。建议集中努力就TBI病例确认达成共识。这样做将使该领域为未来的冲突做好更好的准备，并改善非战斗环境中的监测，筛查和诊断，以及我们了解TBI长期影响的能力。
Challenges associated with case ascertainment of traumatic brain injuries (TBI) sustained during the Afghanistan/Iraq military operations have been widespread. This study was designed to examine how the prevalence and severity of TBI among military members who served during the conflicts were impacted when a more precise classification of TBI diagnosis codes was used compared to the Department of Defense Standard Surveillance Case-Definition. Identification of TBI diagnoses in the Department of Defense’s Military Health System from October 7, 2001 until December 31, 2019. Military members with a TBI diagnosis on an encounter record during the study window. Descriptive observational study to evaluate the prevalence and severity of TBI with regards to each code set (i.e., the DoD-Case-Definition and the more precise set of TBI diagnosis codes). The frequencies of index TBI severity were compared over time and further evaluated against policy changes. The more-precise TBI diagnosis code set excludes the: 1) DoD-only extender codes, which are not used in other healthcare settings; and, 2) non-precise TBI codes, which include injuries that do not necessarily meet TBI diagnostic criteria. When comparing the two TBI classifications, the DoD-Case-Definition captured a higher prevalence of TBI; 38.5% were classified by the DoD-Case-Definition only (>164,000 military members). 73% of those identified by the DoD-Case-Definition only were diagnosed with nonprecise TBI codes only, with questionable specificity as to whether a TBI occurred. We encourage the field to reflect on decisions made pertaining to TBI case ascertainment during the height of the conflicts. Efforts focused on achieving consensus regarding TBI case ascertainment are recommended. Doing so will allow the field to be better prepared for future conflicts, and improve surveillance, screening, and diagnosis in non-combat settings, as well as our ability to understand the long-term effects of TBI.