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Traumatic Brain Injury Following Military Deployment

Evaluation of Diagnosis and Cause of Injury

Regasa, Lemma Ebssa, PhD; Agimi, Yll, PhD; Stout, Katharine C., DPT

The Journal of Head Trauma Rehabilitation: January/February 2019 - Volume 34 - Issue 1 - p 21–29
doi: 10.1097/HTR.0000000000000417
TBI in the Military 2019

Objective: To evaluate the prevalence of delayed traumatic brain injury (TBI) diagnosis and cause of injury that resulted in a TBI diagnosis after military deployment.

Design: Medical record notes were reviewed in 2016 from a random sample of 1150 US military service members who had their first-time deployment in 2011 and likely sustained a TBI. Location and cause of the injury were extracted from the progress note for analysis.

Participants and Setting: Active-duty US military service members who received an International Classification of Diseases, Ninth Revision code for a TBI diagnosis in a military facility.

Main Outcome Measures: Presence of TBI, location of injury, cause of injury, and time of diagnosis with respect to deployment.

Results: The odds of being diagnosed with a deployment-related TBI were 8 times higher during the first 4 weeks upon return from deployment than the subsequent 32 weeks. The likelihood of diagnosing a deployment-sustained TBI during weeks 5 to 32 was 2 times higher than during 33 to 76 weeks following return from deployment. The proportion of deployment-related TBI diagnoses decreased with time following return from deployment but remained above 40% during weeks 33 to 76. Service branch, gender, race, occupation, and time between TBI diagnosis and return from deployment were significant predictors of deployment-related TBIs. Moving motor vehicle, sports, parachute, and being struck by objects were the top causes of injury in garrison (nondeployed setting), whereas blast produced the majority (66%) of all causes of injuries that resulted in a TBI in the deployed setting.

Conclusion: The increased incidence rate of a TBI diagnosis following deployment can be attributed to delayed diagnosis of TBI sustained from injuries during deployment. TBIs sustained during deployment can be diagnosed beyond the initial 4 weeks after return from deployment and may continue up to 76 weeks following return from deployment.

Defense and Veterans Brain Injury Center (DVBIC), Silver Spring, Maryland (Drs Regasa, Agimi, and Stout); General Dynamics Information Technology (GDIT), Fairfax, Virginia (Dr Regasa); and Information Innovators, Inc, Springfield, Virginia (Dr Agimi).

Corresponding Author: Lemma Ebssa Regasa, PhD, Defense and Veterans Brain Injury Center (DVBIC), 1335 East West Hwy, Ste 400, Silver Spring, MD 20910 (

This material was supported by Defense and Veterans Brain Injury Center (DVBIC). No outside sources contributed to the funding of this study. The authors gratefully acknowledge medical record review efforts provided by Dr Michael Thomas and teams of the Office of Surveillance at DVBIC. Comments provided by colleagues at DVBIC and participants during the DVBIC Journal Club presentation in improving the earlier version of this article are also acknowledged.

The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official US Department of Defense position, policy, or decision unless so designated by other official documentation.

The authors declare no conflicts of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.