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NNMC Reviews OIF Brain Injuries

The National Naval Medical Center (NNMC) in Bethesda recently published an article in the Journal of Trauma on severe traumatic brain injuries (TBI) that occurred during Operation Iraqi Freedom (OIF).

The great majority of service members with severe TBI from OIF have received definitive care at NNMC or Walter Reed Army Medical Center (WRAMC). This study was a review of all cases of patients with penetrating or closed head injuries that occurred in OIF, who received neurosurgical evaluations at NNMC or WRAMC. The patients who were evacuated out of theater to receive treatment at these hospitals were at the most severe end of the spectrum of TBI cases.

The study, led by Randy S. Bell, M.D., of NNMC's Department of Neurosurgery, examined the cases of 418 patients during the period of April 2003 to April 2008, including 228 patients with penetrating TBI, 139 patients with severe closed TBI, and 41 patients with an unspecified type of TBI. Explosive blast injury was the most common mechanism of injury (56 percent of the 418 patients). Several types of complications occurred in these patients, such as spinal cord injury, meningitis (brain infection), and pulmonary embolism (blood clot in the lung).

Two serious problems, penetrating brain injuries and deeper levels of coma at time of admission, were associated with longer stays in the intensive care unit and with multiple traumatic injuries in other parts of the body (polytrauma). The functional status of the patients was determined one to two years after hospital discharge. The authors concluded that these patients required complex medical treatment, which incorporated optimal treatment of all organs in the body.



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