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Traumatic Brain Injury Screening: Preliminary Findings in a US Army Brigade Combat Team

Terrio, Heidi MD, MPH; Brenner, Lisa A. PhD; Ivins, Brian J. MS; Cho, John M. MD; Helmick, Katherine MS, CRNP; Schwab, Karen PhD; Scally, Katherine MS, ANP-C; Bretthauer, Rick PA-C; Warden, Deborah MD

Section Editor(s): French, Louis M. PsyD

Journal of Head Trauma Rehabilitation: January-February 2009 - Volume 24 - Issue 1 - p 14–23
doi: 10.1097/HTR.0b013e31819581d8

Objectives The objective of this article is to report the proportion of soldiers in a Brigade Combat Team (BCT) with at least 1 clinician-confirmed deployment-acquired traumatic brain injury (TBI) and to describe the nature of sequelae associated with such injuries.

Participants Members of an Army unit (n = 3973) that served in Iraq were screened for history of TBI. Those reporting an injury (n = 1292) were further evaluated regarding sequelae. Of the injuries suffered, 907 were TBIs and 385 were other types of injury. The majority of TBIs sustained were mild.

Methods Postdeployment, responses to the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT) facilitated clinical interviews regarding injury history and associated somatic (ie, headache, dizziness, balance) and neuropsychiatric symptoms (ie, irritability, memory). Traumatic brain injury diagnosis was based on the American Congress of Rehabilitation Medicine mild TBI criteria, which requires an injury event followed by an alteration in consciousness.

Results A total of 22.8% of soldiers in a BCT returning from Iraq had clinician-confirmed TBI. Those with TBI were significantly more likely to recall somatic and/or neuropsychiatric symptoms immediately postinjury and endorse symptoms at follow-up than were soldiers without a history of deployment-related TBI. A total of 33.4% of soldiers with TBI reported 3 or more symptoms immediately postinjury compared with 7.5% at postdeployment. For soldiers injured without TBI, rates of 3 or more symptoms postinjury and postdeployment were 2.9% and 2.3%, respectively. In those with TBI, headache and dizziness were most frequently reported postinjury, with irritability and memory problems persisting and presenting over time.

Conclusion Following deployment to Iraq, a clinician-confirmed TBI history was identified in 22.8% of soldiers from a BCT. Those with TBI were significantly more likely to report postinjury and postdeployment somatic and/or neuropsychiatric symptoms than those without this injury history. Overall, symptom endorsement decreased over time.

From the Department of Deployment Health and Headquarters, Evans Army Community Hospital, Fort Carson, Colorado (Drs Terrio and Cho, Ms Scally, and Mr Bretthauer); VA VISN 19 Mental Illness Research Education and Clinical Center, Denver, Colorado, and Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Denver (Dr Brenner); and The Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center, Washington, DC (Drs Terrio, Schwab, and Warden, Mr Ivins, and Ms Helmick).

Corresponding author: Heidi Terrio, MD, MPH, 1853 O'Connell Blvd, Bldg 1042, Room 107, Fort Carson, CO 80913 (e-mail:

The views expressed in this article are those of the authors and do not reflect official policy or position of the Department of Defense, the US Government, or any of the institutional affiliations listed.

This project could not have been completed without the tremendous effort put forth by the Fort Carson Soldier Readiness Center Staff. The authors also acknowledge the support provided by the Fort Carson Leadership, Evans Community Hospital staff, Great Plains Regional Medical Command, Office of the Army Surgeon General, Defense and Veterans Brain Injury Center, and TBI Task Force. In addition, the editorial assistance of Dr Sheila Saliman and Lisa Betthauser is greatly appreciated.

© 2009 Lippincott Williams & Wilkins, Inc.