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Frank Tortella, PhD: TBI Is Biggest Combat Casualty

TBI Is Biggest Combat Casualty

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The challenge today that the military is addressing with regard to TBI is really quite significant. With the emergence of these new conflicts that we are now involved in Iraq and of course now Afghanistan the military in a sense has been exposed to a new kind of warfare. That involves a lot of blast and IED - the public reads about these IEDs which is an improvised explosive device, and RPG, which is a rocket-propelled grenade. So it's not the traditional bullets and mortars in a sense of blast conflicts and what's emerged because of this type of weaponry and because of the way our enemy is using it is a tremendously high incidence of traumatic brain injury particularly what's referred to as the mild traumatic brain injury or the concussive-type brain injury. Prior to these conflicts, historically, when we thought of the military problem of traumatic brain injury was gunshot wounds to the head and to the upper torso. Or high-velocity fragments from grenades, for example. And that still persists. There has been close to 3500 severe TBIs so far from these two conflicts caused by gunshot wounds. But the mild TBI caused by blast is a real issue. And it's a real issue because it's hard to diagnose, it's very difficult to identify. Unlike in sports, football for example, you see the impact, you see the event. You can assess the athlete's condition immediately. We don't have that ability in theater with that level of sophistication to really do that so a lot of the diagnosis is taking place days, weeks, months after and so there may be a lot of under-diagnosed, misdiagnosed issues but the numbers are enormous. It has been estimated that there have been 300,000 mild TBIs already. The confirmed diagnoses through the first 10 years, 9 years, of the conflict borders on the order of about 155,000 diagnosed mild TBIs. But again, the caveat is, how strong are those diagnoses? Because there is a lot of symptomatology that you see with mild TBI that also is seen with other conditions, like just depression the stress of the environment, the stress of combat post-traumatic stress disorder, PTSD, which, again, has been published and printed quite prolifically in the press. This problem facing the military is, particularly in terms of - not mortality, not killed in actions, not post-conflict mortality but in terms of what we call the morbidity, the post-injury quality of life for the soldier. In terms of that, TBI is probably now our biggest combat casualty care issue. And by combat casualty care, I'm specifically referring to injuries that occur as a result of combat or involvement in combat.

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The changes in weaponry during the recent conflicts compared with weaponry in previous wars have made TBI, especially mTBI, a common and complex injury among returning service members.

See more videos with Dr. Frank Tortella.


Produced by Brian King and Noel Guther, BrainLine.

Frank C. Tortella, ST, PhDFrank C. Tortella, ST, PhD, Frank Tortella, ST, PhD serves as the U.S. Army’s Medical Research and Material Command’s subject matter expert on neurotrauma and neuroprotection research for a diverse range of insults to include traumatic brain injury, concussions, and the neurological effects of blast exposure.

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