TBI: "signature wound"

I suppose it is good news that more soldiers from the Iraq debacle are surviving. But there is a flip side. Traumatic Brain Injury (TBI).

"Traumatic brain injury is the signature wound of this war," said Lt. Col. Rocco Armonda, an attending neurosurgeon at the National Naval Medical Center in Bethesda, Md. [In the first year of the war Armonda and his colleagues] performed 270 brain surgeries, 60 of which were for penetrating wounds. "In previous conflicts, most of these people would have died," Armonda said.

In the following year, Armonda said, neurosurgeons doubled the number of craniectomies, in which part of the skull is removed to accommodate brain swelling. According to the New England Journal of Medicine, mortality from brain injuries in the Vietnam War was 75 percent or greater, with 12 to 14 percent of all combat casualties having a brain injury. In the Iraq and Afghanistan conflicts, traumatic brain injury accounted for 22 percent or higher of the injuries - a larger proportion of casualties than it has in other recent U.S. wars. (Newsday)

Many of the TBI symptoms are cognitive: memory and attention problems, inability to speak clearly or carry out certain kinds of thinking tasks, headaches, thought disorders, forgetting words. Some have personality changes. Others have disinhibition, irritability, anxiety and depression. Sometimes the symptoms get better. Often they don't.

It is not just penetrating wounds but concussions from proximity to strong explosions.

Doctors at Walter Reed Army Medical Center in Washington, D.C., are assessing all injured troops returning from Iraq. As many as 60 percent have brain injuries, the [New England Journal] reported. Some are mild. Most are moderate to severe. "There is a good chance that they will be living with symptoms for a long time," [Dr. Susan Oakie] said [writing in the journal].

Sixty percent of injured soldiers [see clarification below] with Traumatic Brain Injury. With kevlar vests and helmets. What if you were an Iraqi civilian?

Clarification, 1:57 pm, 5/25/05: I have gone back to check the figures in the NEJM paper, as I was bothered by the 60% figure in the Newsday quote, above. The 60% figure does appear there (actually it is 59%) but refers specifically to admitted patients exposed to a blast (as from an IED). The best data I can find on the proportion of injuries due to blast suggests it is about 50%. Thus the proportion of all injuries with TBI would seem to be 30%, still a horrendous figure. We apologize for the lack of clarity here, for which we take responsibility.