Heidi Terrio talks with
ScienceWatch.com and answers a few questions about
this month's Fast Breaking Paper Paper in the field of Social
Article Title: Traumatic Brain Injury Screening:
Preliminary Findings in a US Army Brigade Combat
Authors: Terrio, H;Brenner, LA;Ivins, BJ;Cho,
JM;Helmick, K;Schwab, K;Scally, K;Bretthauer, R;Warden, D
Journal: J HEAD TRAUMA REHABIL, Volume: 24, Issue: 1, Page:
14-23, Year: JAN-FEB 2009
* 1853 Oconnell Blvd,Bldg 1042,Room 107, Ft Carson, CO 80913
* Evans Army Community Hosp, Dept Deployment Hlth &
Headquarters, Ft Carson, CO USA.
* VA VISN 19 Mental Illness Res Educ & Clin Ctr, Denver, CO
USA. (addresses have been
Why do you think your paper is highly
This paper is a descriptive study on deployment-acquired traumatic brain
injury (TBI). A TBI is most simply described as an injury event that
results in an alteration or loss of consciousness. Data was: 1) obtained
from one Brigade Combat Team (BCT); 2) included the percentage of soldiers
with history of clinician confirmed TBI; and 3) collected within 10 days of
the soldiers returning from Iraq.
Information regarding common symptoms experienced post-TBI (immediately
after the injury and at the post-deployment) was also obtained. Blast was
the most common injury mechanism among soldiers in this unit.
Does it describe a new discovery, methodology, or
synthesis of knowledge?
In the manuscript, a new self-administered tool, the Warrior Administered
Retrospective Casualty Assessment Tool (WARCAT), for ascertaining detailed
information regarding injury events was described.
"Social consequences of this information include
collaboration between organizations in a way that has never
been seen before, e.g., the Army, Navy, Marines, and Air
Force, the Department of Veterans Affairs, the Defense and
Veteran's Brain Injury Center, the Brain Injury Association
of America, the National Football League, etc., each
Procedures for using the WARCAT to guide medical providers in completing a
structured clinical interview were also detailed. Structured clinical
interview is the "gold standard" for assessing a history of mild TBI.
Would you summarize the significance of your
paper in layman’s terms?
The findings in this study highlight that mild traumatic brain injury is a
common deployment injury. The natural course of mild TBI in this BCT was
that most soldiers improved in terms of post-TBI symptoms (e.g., headache)
between the time of injury and returning home.
Nevertheless, 7.5% report three or more symptoms post-deployment. We
believe that the methodology described above may assist in the accurate
documentation of injuries sustained during deployment.
Using these strategies during the Post-Deployment Health Assessment (PDHA)
may assist in evaluating symptoms that emerge long after the soldier has
returned to the United States.
How did you become involved in this research, and
were there any problems along the way?
The research was pursued as a request from U.S. Army leaders to accurately
evaluate soldiers during the PDHA in relation to blast injury and possible
traumatic brain injury.
Despite the emphasis by the military services to assess and document these
injuries at the time of the incident, there are barriers to seeking
evaluation in theatre (e.g., wanting to stay with their team, not realizing
that they were injured, and the belief that others were injured worse).
Policies to date have resulted in soldiers coming forward with symptoms
Where do you see your research leading in the
This research highlights the need for investigation of the natural history
of TBI acquired during deployment, tools to best assess TBI (e.g.,
biomarkers, advanced imaging technologies, balance and vestibular
assessments, neuropsychiatric measures) and interventions to aid in
The current research has allowed identification of a population of service
members who need to be tracked in order to determine the natural history of
Data recently collected by our team, described in Brenner LA, et
al.,Journal of Head Trauma Rehabilitation 25:1,
January/February 2010, suggested that mild TBI and posttraumatic stress
disorder were independently associated with postconcussive symptom
In addition, those with both conditions were at greater risk for
postconcussive symptoms than those with mild TBI alone, posttraumatic
stress disorder alone, or neither. This conclusion appears consistent with
a combined biological and psychological model of post-combat symptoms.
These findings support the importance of screening for both conditions with
the future aim of treatment in a more collaborative interdisciplinary
Do you foresee any social or political
implications for your research?
The social and political consequence of this research is one of awareness
and a change in procedures concerning this unseen injury. Having shown a
large cohort of soldiers in one Army BCT to have up to 22.8% with a history
of a combat TBI, most of which were not documented in the theatre of
operation, has brought awareness for the need to enforce screening at the
time of the injury.
New policies are being developed that require all persons involved in a
blast within 50 meters, a severe motor vehicle accident, sustaining a
direct blow to the head, or a loss of consciousness, as well as
command-directed referrals, to be screened for TBI.
This is also important since the classification of TBI as mild, moderate,
and severe is based on the history of what happened at the time of the
injury. Guidelines on recurrent concussions will also be implemented and
involve mandatory rest and evaluation.
Social consequences of this information include collaboration between
organizations in a way that has never been seen before, e.g., the Army,
Navy, Marines, and Air Force, the Department of Veterans Affairs, the
Defense and Veteran's Brain Injury Center, the Brain Injury Association of
America, the National Football League, etc., each contribute.
All of these organizations are coming together to share ideas in education,
caretaker support, care coordination, evaluation, and research.
Additionally, we have seen an interdisciplinary approach to evaluation and
treatment for mild TBI, which had previously been seen only in polytrauma
centers among the more severely injured.
Heidi Terrio, M.D., M.P.H.
Colonel, US Army Medical Corps
Chief, Clinical Investigations
Department of Deployment Health
Fort Carson, CO, USA