Kimberly Meyer

A Brief Overview of Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD) Within the Department of Defense

The current conflicts in the Middle East have yielded increasing awareness of the acute and chronic effect of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The increasing frequency of exposure to blast and multiple deployments potentially impact the probability that a service member may sustain one of these injuries. The 2008 International Conference on Behavioral Health and Traumatic Brain Injury united experts in the fields of behavioral health and traumatic brain injury to address these significant health concerns. This article summarizes current Department of Defense (DoD) initiatives related to TBI and PTSD.

Combat-Related Traumatic Brain Injury and Its Implications to Military Healthcare

Traumatic brain injury (TBI) is a known injury in todays combat arena. Improved screening and surveillance methods have diagnosed TBI with increasing frequency. Current treatment plans are based largely on information gleaned from sports injuries. However, these management paradigms fail to address the effect of physiologic stress (fatigue, dehydration) and psychological stress at the time of injury as well as the number of previous concussions that may affect recovery from combat-related TBI. This article presents current evaluation and management of combat-related injury and discusses other psychological conditions that may coexist with TBI.

Mild traumatic brain injury screening, diagnosis, and treatment.

The majority of combat-related traumatic brain injury (TBI) within the U.S. Armed Forces is mild TBI (mTBI). This article focuses specifically on the screening, diagnosis, and treatment aspects of mTBI within the military community. Aggressive screening measures were instituted in 2006 to ensure that the mTBI population is identified and treated. Screenings occur in-theater, outside the contiguous United States, and in-garrison. We discuss specific screening procedures at each screening setting. Current diagnosis of mTBI is based upon self-report or through witnesses to the event. TBI severity is determined by specific Department of Defense criteria. Abundant clinician resources are available for mTBI in the military health care setting. Education resources for both the patient and the clinician are discussed in detail. An evidence-based clinical practice guideline for the care of mTBI was created through collaborative efforts of the DoD and the U.S. Department of Veterans Affairs. Although symptoms following mTBI generally resolve with time, active treatment is centered on symptom management, supervised rest, recovery, and patient education. Medical specialty care, ancillary services, and other therapeutic services may be required.

Successful incorporation of the Severe Head Injury Guidelines into a phased-outcome clinical pathway.

&NA; Clinical pathways have been proven to be valu able tools in improving outcomes in patients with neuro logical diagnoses. However, their use with trauma populations has been limited. The unpredictable nature of trauma makes it difficult to develop a day‐by‐day plan of care that would be applicable to all patients with the same trauma diagnosis. Nev ertheless, a severe traumatic brain injury (TBI) clinical pathway was developed and implemented at a Level 1 Trauma Center with significant reductions in length of stay and number of ven tilator days. With the publication of the Guidelines for the Management of Severe Head Injury, this pathway was refashioned into a severe TBI phased‐outcome pathway. Rather than a day‐by‐day plan of care, this clinical pathway consists of four phases of care: (a) admission to the intensive care unit, (b) acute critical care, (c) mobility and weaning, and (d) pre‐reha bilitation. After 12 months, the improvements accomplished by the original pathway have been maintained or exceeded.

Trend and Geographic Analysis for Traumatic Brain Injury Mortality and Cost Based on MarketScan Database

The objective of the current research was to examine the current epidemiology of traumatic brain injury (TBI); to determine the effects of geographic region, co-morbidities, year of injury, injury severity, and demographics on hospital costs, length of stay (LOS), and mortality. All subjects were drawn from the Thomason Reuters MarketScan(®) database. Statistical methods used included descriptive analysis, bivariate analysis, logistic regression, and the Geographic Information System (GIS) software, ArcMap. We studied 76,313 patients with TBI from 2004 to 2009 (52,721 with commercial insurance and 23,592 with Medicare) from the MarketScan database. As age increased, mortality rate and median LOS increased. The median hospital costs for adults were the highest (

Continuous infusion of low-dose unfractionated heparin after aneurysmal subarachnoid hemorrhage: a preliminary study of cognitive outcomes

13,000 for ages 18-64) compared with children (

Effects of non-neurological complications on traumatic brain injury outcome

8000 for age 0-14) and elderly persons (

A phased-outcome clinical pathway for the management of moderate traumatic brain injury

9000 for age ≥ 65). The mortality rate for the elderly population has decreased slightly (11.1% in 2004 to 9.9% in 2009 for men, and 7.0% to 6.9% for women); however, their hospital costs have increased significantly (

Use of an acute spinal cord injury clinical pathway.

6899 in 2004 to

Military Personnel and Veterans With Traumatic Brain Injury

11,567 in 2009 for men;