| Last updated on 2009-08-06 09:44:33 |
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Institute of Medicine Reports on Traumatic Brain Injury and Long-Term Health Problems December 18, 2008 Many of the recommendations made in a new report by the Institute of Medicine (IOM) on the long-term health effects of traumatic brain injury (TBI) in the military have already been adopted by the Department of Defense (DoD). Gulf War and Health: Volume 7, Long-term Consequences of Traumatic Brain Injury has specific recommendations that are consistent with earlier studies and reports, including ones by the Defense Health Board and the Army TBI Task Force. "The Institute of Medicine report provides significant validation of Department of Defense initiatives already underway," said Deputy Assistant Secretary of Defense for Force Health Protection and Readiness Ellen Embrey. "We are pleased that the Institute of Medicine has reached the same conclusions as we have." For example, the IOM study recommends that DoD conduct pre-deployment neurocognitive tests of all service members to establish a baseline to make it easier to evaluate those who experience a traumatic brain injury. DoD has begun this testing over the past year, and has so far tested more than 100,000 members of the military. In another example, the IOM study recommends screening service members for TBI after they return from deployments. DoD is already doing this as part of its post-deployment health assessment, and using the screening tool recommended by the IOM. In fact, DoD developed the screening tool. The vast majority of TBI cases in the armed forces - between 87 and 90 percent - involve mild TBI, also known as concussion. DoD agrees with the IOM that more study is needed of the long-term consequences of these and more serious traumatic brain injuries, and that more study is also needed on the cumulative effect of repeat concussions. In addition, because DoD agrees with the IOM that more study is needed, it will launch a longitudinal study in the next several months that will continue for the next 15 years to follow the health of 1,600 service members who have experienced TBI. The IOM published its report Dec. 4 after conducting a medical literature review to look for associations between TBI and long-term health problems. The IOM defined long-term as effects that were present six months after the injury. The review was conducted in response to a request from the Department of Veterans Affairs (VA), which sponsored the study. The details of the DoD initiatives follow this article. After an assessment of 30,000 titles and abstracts, IOM identified 1,900 studies for further review. IOM included TBI from any mechanism: occupational injury, motor vehicle accident, sports injury, gunshot wound or other act of violence, including military combat. IOM was requested to consider the severity of TBI and possible long-term effects. The institute used four categories of TBI: penetrating, severe, moderate and mild. IOM relied upon the definitions of these groups that were used by the authors of the studies. IOM evaluated several outcomes that were associated with TBI, including neurological effects, such as seizures and dementia; psychiatric effects, such as depression and PTSD; and psychosocial effects, such as unemployment and aggressive behaviors. IOM determined that some short-term outcomes resolved or lessened over time (such as some neurocognitive and psychosocial dysfunction), while other outcomes became more apparent years after the injury (such as some psychiatric outcomes). There were varying levels of evidence for an association of TBI and different outcomes. The levels included "causal relationship between TBI and an outcome," "sufficient evidence of an association," "limited or suggestive evidence of an association," and "inadequate or insufficient evidence of an association." This IOM report has substantial clinical implications for DoD. Health care providers need to consider the likely long-term conditions or symptoms of TBI to optimize the long-term care of their TBI patients. The DoD disability system will need to consider the possible links between those symptoms and a past history of TBI that occurred years before. More on the IOM report can be found at http://www.iom.edu/CMS/4683/60519.aspx. For a related article, click here |
