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Mild Traumatic Brain Injury

Volume 470: debated on Tuesday 15 January 2008

In the light of parliamentary and public interest in traumatic brain injuries (TBI) arising in current conflicts, I am pleased to report the status of work being conducted on this topic by the Defence Medical Services.

TBI are seen in both military and civilian populations, occurring when the skull and brain are exposed to acute changes in velocity such as road traffic accidents and contact sports, as well as exposure to blasts and other concussions to the head. Severe and moderate cases are generally readily identifiable to medical practitioners and will be managed by established clinical and rehabilitation programmes. The Defence Medical Services already routinely screens all personnel with multiple injuries admitted to MOD’s main rehabilitation centre at Headley Court for symptoms and signs of brain injury, and where necessary special investigations are undertaken to identify the nature and degree of any structural damage to the brain.

However, mild traumatic brain injury (MTBI) can be less easy to recognise and diagnose. It may result from relatively minor head injuries, and symptoms can be both wide-ranging and delayed in their onset, as well as being similar to those of other recognised disorders such as post-concussion syndrome and post-traumatic stress disorder (PTSD).

Recognising the need for further research, the MOD’s surgeon general initiated a project in June 2007 to investigate the historical, clinical and laboratory context of MTBI and make recommendations concerning future management, clinical care, education and research. The project team consulted widely with clinical and research experts within the military and civilian sectors both in the UK and overseas, principally the US.

The project noted that civilian evidence suggests 80 per cent. of TBI is mild and 80 per cent of cases will be symptom-free within three months of exposure. The project concluded that there was no evidence to suggest that the operational capability of the UK’s armed forces was being affected by MTBI. The Royal Centre for Defence Medicine (RCDM) has identified 585 cases of casualties with traumatic brain injury (whether mild, moderate or severe) out of some 36,000 total attendances for any medical condition to deployed UK operational emergency departments between early 2003 and November 2007—the majority of which would be for minor ailments with no requirement for admission or, in many cases, further treatment. This represents 1.6 per cent. of all medical presentations during the period, and 0.5 per cent. of the deployed UK military population.

The project has provided a baseline for further work that is already in hand. A four-level protocol is being established by staff at Headley Court for the diagnosis and treatment of MTBI cases. Guidance has been promulgated to all defence general practitioners advising them about MTBI and the treatment options available. Education material has been developed, aimed at all personnel on deployed operations, and an assessment questionnaire is being introduced to help medical staff identify MTBI cases at the time of injury and to enhance surveillance and research.

Research is also continuing into such areas as identification and diagnosis of MTBI cases, and also their prevention. Throughout our research we are in touch with United States developments, and collaborating with its researchers as appropriate.