Concussion/mTBI Screening

RATIONALE

Unlike a severe or even moderate traumatic brain injury (TBI), a concussion or mild traumatic brain injury (mTBI) may not be readily identified. Recognizing the importance of early detection, the Department of Defense (DoD) and Department of Veterans Affairs (VA) have established system-wide screening and assessment procedures to identify concussion/mTBI in service members and veterans at the soonest opportunity and through multiple points of care.

Screening for concussion/mTBI involves a quick evaluation of possible exposure to a traumatic event including injuries that may occur during deployment, leave, or even civilian life following active duty. Clinicians work to establish if there was an alteration of consciousness (AOC) associated with the injury or traumatic event, and if the event resulted in any neurologic changes or symptoms. 

IN-THEATER

Ideally, screening should occur immediately following the injury event or as soon as operationally feasible. The Military Acute Concussion Evaluation (MACE) is a screening tool developed by DVBIC in 2006 that allows medics/corpsmen and front line providers to quickly measure four cognitive domains: orientation, immediate memory, concentration, and memory recall. When combined with other clinical information, the MACE score can help reveal basic cognitive performance and guide recommendations including evacuation to a higher level of care. The MACE is currently undergoing further validation studies in a combat environment and DVBIC continues to work to ensure screening for concussion/mTBI at all levels and environments of care. The MACE alone does not diagnose concussion/mTBI.

LANDSTUHL REGIONAL MEDICAL CENTER

Service members with significant injuries or non-battle medical conditions that require evacuation from theater, undergo screening for concussion/mTBI at Landstuhl Regional Medical Center (LRMC). This process identifies any history of previous brain injury (combat or non-combat related) and assesses for the presence or absence of current concussion/mTBI-related symptoms. Identification of newly symptomatic patients results in triage to a stateside medical facility that can more fully evaluate and, if necessary, provide treatment for concussion/mTBI.

POST-DEPLOYMENT

Because concussion/mTBI is not always recognized in the combat setting, screening of active duty service members also occurs through post-deployment health assessments (PDHA). Four questions, that are adapted from the Brief Traumatic Brain Injury Survey (BTBIS), appear on the PDHA. Positive responses on all four questions should prompt a clinician interview to more fully evaluate for concussion/mTBI.

VETERANS

Screening for concussion/mTBI of veterans occurs upon entry into the Veterans Health Administration (VHA) system, using a TBI Clinical Reminder tracking system. The first step of the reminder is to identify possible Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) participants based on whether date of separation from military duty or Active Duty status occurred after September 11, 2001. The screening for concussion/mTBI is done once for all individuals who report deployment to OEF/OIF Theaters. For those who confirm OEF/OIF deployment and do not have a prior diagnosis of concussion/mTBI, the instrument proceeds using four sequential sets of questions, once again based on the BTBIS. Arrangements for further evaluation are offered for those who screen positive for concussion/mTBI.

CONCLUSION

It is important to realize that not all individuals whose screen is positive have a concussion/mTBI.

Positive screens are always followed up by a clinical interview and examination to confirm or negate the diagnosis of a concussion/mTBI.

If you are a service member or veteran and believe you may have sustained a concussion/mTBI, DVBIC can help. Call us at 1.800.870.9244 or use our Contact Us form to send a message online.