Military traumatic brain and spinal column injury

A 5-year study of the impact blast and other military grade weaponry on the central nervous system

Randy S. Bell, Alexander Vo, Christopher J. Neal, June Tigno, Ryan Roberts, Corey Mossop, James R. Dunne, Rocco A. Armonda

Research output: Contribution to journalArticle

129 Citations (Scopus)

Abstract

BACKGROUND: During the past 5 years of Operation Iraqi Freedom (OIF), a significant majority of the severe closed and penetrating head trauma has presented for definitive care at the National Naval Medical Center (NNMC) in Bethesda, MD, and at the Walter Reed Army Medical Center (WRAMC) in Washington, DC. The purpose of this article is to review our experience with this population of patients. MATERIALS: A retrospective review of all inpatient admissions from OIF was performed during a 5-year period (April 2003 to April 2008). Criteria for inclusion in this study included either a closed or penetrating head trauma suffered during combat operations in Iraq who subsequently received a neurosurgical evaluation at NNMC or WRAMC. Exclusion criteria included all patients for whom primary demographic data could not be verified. Primary outcome data included the type and mechanism of injury, Glasgow coma scale (GCS) and injury severity score at admission, and Glasgow outcome scale (GOS) at discharge, 6 months, and 1 to 2 years. RESULTS: Five hundred thirteen consultations were performed by the neurosurgery service on the aforementioned population. Four hundred eight patients met the inclusion criteria for this study (401:7, male: female; 228 penetrating brain injury, 139 closed head injury, 41 not specified). Explosive blast injury (229 patients; 56%) constituted the predominant mechanism of injury. The rates of pulmonary embolism (7%), cerebrospinal fluid leak (8.6%), meningitis (9.1%), spinal cord or column injury (9.8%), and cerebrovascular injury (27%) were characterized. Cerebrospinal fluid leak, vasospasm, penetrating head injury, and lower presenting GCS were statistically associated with longer intensive care unit stays and higher presenting injury severity scores (p <0.05). While presenting GCS 3-5 correlated with worsened short-term and long-term GOS scores (p <0.001), almost half of these patients achieved GOS ≥3 at 1- to 2-year follow-up. Total mortality after reaching NNMC/WRAMC was 4.4%. CONCLUSIONS: OIF has resulted in the highest concentration of severe closed and penetrating head trauma to return to NNMC and WRAMC since the Vietnam Conflict. Management scenarios were complex, incorporating principles designed to maximize outcomes in all body systems. Meaningful survival can potentially be achieved in a subset of patients with presenting GCS ≤5.

Original languageEnglish (US)
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume66
Issue numberSUPPL. 4
DOIs
StatePublished - Apr 2009

Fingerprint

Penetrating Head Injuries
Spinal Injuries
2003-2011 Iraq War
Closed Head Injuries
Glasgow Coma Scale
Spine
Central Nervous System
Glasgow Outcome Scale
Brain
Injury Severity Score
Wounds and Injuries
Vietnam Conflict
Blast Injuries
Iraq
Neurosurgery
Pulmonary Embolism
Meningitis
Population
Intensive Care Units
Inpatients

Keywords

  • Military
  • Spinal column injury
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Military traumatic brain and spinal column injury : A 5-year study of the impact blast and other military grade weaponry on the central nervous system. / Bell, Randy S.; Vo, Alexander; Neal, Christopher J.; Tigno, June; Roberts, Ryan; Mossop, Corey; Dunne, James R.; Armonda, Rocco A.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 66, No. SUPPL. 4, 04.2009.

Research output: Contribution to journalArticle

Bell, Randy S. ; Vo, Alexander ; Neal, Christopher J. ; Tigno, June ; Roberts, Ryan ; Mossop, Corey ; Dunne, James R. ; Armonda, Rocco A. / Military traumatic brain and spinal column injury : A 5-year study of the impact blast and other military grade weaponry on the central nervous system. In: Journal of Trauma - Injury, Infection and Critical Care. 2009 ; Vol. 66, No. SUPPL. 4.
@article{7f3b326c72aa4c46885151b0381846cc,
title = "Military traumatic brain and spinal column injury: A 5-year study of the impact blast and other military grade weaponry on the central nervous system",
abstract = "BACKGROUND: During the past 5 years of Operation Iraqi Freedom (OIF), a significant majority of the severe closed and penetrating head trauma has presented for definitive care at the National Naval Medical Center (NNMC) in Bethesda, MD, and at the Walter Reed Army Medical Center (WRAMC) in Washington, DC. The purpose of this article is to review our experience with this population of patients. MATERIALS: A retrospective review of all inpatient admissions from OIF was performed during a 5-year period (April 2003 to April 2008). Criteria for inclusion in this study included either a closed or penetrating head trauma suffered during combat operations in Iraq who subsequently received a neurosurgical evaluation at NNMC or WRAMC. Exclusion criteria included all patients for whom primary demographic data could not be verified. Primary outcome data included the type and mechanism of injury, Glasgow coma scale (GCS) and injury severity score at admission, and Glasgow outcome scale (GOS) at discharge, 6 months, and 1 to 2 years. RESULTS: Five hundred thirteen consultations were performed by the neurosurgery service on the aforementioned population. Four hundred eight patients met the inclusion criteria for this study (401:7, male: female; 228 penetrating brain injury, 139 closed head injury, 41 not specified). Explosive blast injury (229 patients; 56{\%}) constituted the predominant mechanism of injury. The rates of pulmonary embolism (7{\%}), cerebrospinal fluid leak (8.6{\%}), meningitis (9.1{\%}), spinal cord or column injury (9.8{\%}), and cerebrovascular injury (27{\%}) were characterized. Cerebrospinal fluid leak, vasospasm, penetrating head injury, and lower presenting GCS were statistically associated with longer intensive care unit stays and higher presenting injury severity scores (p <0.05). While presenting GCS 3-5 correlated with worsened short-term and long-term GOS scores (p <0.001), almost half of these patients achieved GOS ≥3 at 1- to 2-year follow-up. Total mortality after reaching NNMC/WRAMC was 4.4{\%}. CONCLUSIONS: OIF has resulted in the highest concentration of severe closed and penetrating head trauma to return to NNMC and WRAMC since the Vietnam Conflict. Management scenarios were complex, incorporating principles designed to maximize outcomes in all body systems. Meaningful survival can potentially be achieved in a subset of patients with presenting GCS ≤5.",
keywords = "Military, Spinal column injury, Traumatic brain injury",
author = "Bell, {Randy S.} and Alexander Vo and Neal, {Christopher J.} and June Tigno and Ryan Roberts and Corey Mossop and Dunne, {James R.} and Armonda, {Rocco A.}",
year = "2009",
month = "4",
doi = "10.1097/TA.0b013e31819d88c8",
language = "English (US)",
volume = "66",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "SUPPL. 4",

}

TY - JOUR

T1 - Military traumatic brain and spinal column injury

T2 - A 5-year study of the impact blast and other military grade weaponry on the central nervous system

AU - Bell, Randy S.

AU - Vo, Alexander

AU - Neal, Christopher J.

AU - Tigno, June

AU - Roberts, Ryan

AU - Mossop, Corey

AU - Dunne, James R.

AU - Armonda, Rocco A.

PY - 2009/4

Y1 - 2009/4

N2 - BACKGROUND: During the past 5 years of Operation Iraqi Freedom (OIF), a significant majority of the severe closed and penetrating head trauma has presented for definitive care at the National Naval Medical Center (NNMC) in Bethesda, MD, and at the Walter Reed Army Medical Center (WRAMC) in Washington, DC. The purpose of this article is to review our experience with this population of patients. MATERIALS: A retrospective review of all inpatient admissions from OIF was performed during a 5-year period (April 2003 to April 2008). Criteria for inclusion in this study included either a closed or penetrating head trauma suffered during combat operations in Iraq who subsequently received a neurosurgical evaluation at NNMC or WRAMC. Exclusion criteria included all patients for whom primary demographic data could not be verified. Primary outcome data included the type and mechanism of injury, Glasgow coma scale (GCS) and injury severity score at admission, and Glasgow outcome scale (GOS) at discharge, 6 months, and 1 to 2 years. RESULTS: Five hundred thirteen consultations were performed by the neurosurgery service on the aforementioned population. Four hundred eight patients met the inclusion criteria for this study (401:7, male: female; 228 penetrating brain injury, 139 closed head injury, 41 not specified). Explosive blast injury (229 patients; 56%) constituted the predominant mechanism of injury. The rates of pulmonary embolism (7%), cerebrospinal fluid leak (8.6%), meningitis (9.1%), spinal cord or column injury (9.8%), and cerebrovascular injury (27%) were characterized. Cerebrospinal fluid leak, vasospasm, penetrating head injury, and lower presenting GCS were statistically associated with longer intensive care unit stays and higher presenting injury severity scores (p <0.05). While presenting GCS 3-5 correlated with worsened short-term and long-term GOS scores (p <0.001), almost half of these patients achieved GOS ≥3 at 1- to 2-year follow-up. Total mortality after reaching NNMC/WRAMC was 4.4%. CONCLUSIONS: OIF has resulted in the highest concentration of severe closed and penetrating head trauma to return to NNMC and WRAMC since the Vietnam Conflict. Management scenarios were complex, incorporating principles designed to maximize outcomes in all body systems. Meaningful survival can potentially be achieved in a subset of patients with presenting GCS ≤5.

AB - BACKGROUND: During the past 5 years of Operation Iraqi Freedom (OIF), a significant majority of the severe closed and penetrating head trauma has presented for definitive care at the National Naval Medical Center (NNMC) in Bethesda, MD, and at the Walter Reed Army Medical Center (WRAMC) in Washington, DC. The purpose of this article is to review our experience with this population of patients. MATERIALS: A retrospective review of all inpatient admissions from OIF was performed during a 5-year period (April 2003 to April 2008). Criteria for inclusion in this study included either a closed or penetrating head trauma suffered during combat operations in Iraq who subsequently received a neurosurgical evaluation at NNMC or WRAMC. Exclusion criteria included all patients for whom primary demographic data could not be verified. Primary outcome data included the type and mechanism of injury, Glasgow coma scale (GCS) and injury severity score at admission, and Glasgow outcome scale (GOS) at discharge, 6 months, and 1 to 2 years. RESULTS: Five hundred thirteen consultations were performed by the neurosurgery service on the aforementioned population. Four hundred eight patients met the inclusion criteria for this study (401:7, male: female; 228 penetrating brain injury, 139 closed head injury, 41 not specified). Explosive blast injury (229 patients; 56%) constituted the predominant mechanism of injury. The rates of pulmonary embolism (7%), cerebrospinal fluid leak (8.6%), meningitis (9.1%), spinal cord or column injury (9.8%), and cerebrovascular injury (27%) were characterized. Cerebrospinal fluid leak, vasospasm, penetrating head injury, and lower presenting GCS were statistically associated with longer intensive care unit stays and higher presenting injury severity scores (p <0.05). While presenting GCS 3-5 correlated with worsened short-term and long-term GOS scores (p <0.001), almost half of these patients achieved GOS ≥3 at 1- to 2-year follow-up. Total mortality after reaching NNMC/WRAMC was 4.4%. CONCLUSIONS: OIF has resulted in the highest concentration of severe closed and penetrating head trauma to return to NNMC and WRAMC since the Vietnam Conflict. Management scenarios were complex, incorporating principles designed to maximize outcomes in all body systems. Meaningful survival can potentially be achieved in a subset of patients with presenting GCS ≤5.

KW - Military

KW - Spinal column injury

KW - Traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=68049097187&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=68049097187&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e31819d88c8

DO - 10.1097/TA.0b013e31819d88c8

M3 - Article

VL - 66

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - SUPPL. 4

ER -