Traumatic Brain Injury Classification Variability During the Afghanistan/Iraq Conflicts: Surveillance, Clinical, Research, and Policy Implications.
Rachel Sayko Adams, Peter Hoover, Jeri E Forster and 2 others
PMID 36075868WHAT IT FOUND
Of 426,450 military members with a qualifying TBI diagnosis, 38.5% were captured only by the DoD surveillance rules, and 73% of those had non-precise codes.
A recorded military TBI may not confirm injury.
Key findings
01426,450 military members had a qualifying TBI diagnosis; 61.5% were also captured by the more precise RM-MIRECC code set, while 38.5% were captured only by the DoD-Case-Definition, and 73% of that group had only non-precise codes.
02Index mild TBI was 65.0% under the DoD-Case-Definition and 74.3% under RM-MIRECC; unclassified severity was 25.7% and 20.0%, respectively.
03For worst TBI, mild was 61.8% under the DoD-Case-Definition and 59.1% under RM-MIRECC.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study used diagnosis codes, not clinical assessments, so it cannot tell whether each coded diagnosis was a true TBI. The standard DoD definition included non-precise codes and DoD-only codes, so differences partly reflect code availability rather than only clinical accuracy. ICD-10 codes often lacked severity information, so some records could not be classified by severity. The paper reports classification prevalence and severity, not patient outcomes or whether treatment changed.
Declared interests
The authors reported no conflict of interest.
The easy way to misread this
Do not assume every recorded military TBI diagnosis is a confirmed TBI. 38.5% of members were captured only by the standard DoD surveillance definition, and 73% of those had only non-precise codes.