Defense develops traumatic brain injury databases

To get a better handle on traumatic brain injury, one of the invisible wounds of the wars in Afghanistan and Iraq, the Defense Department is developing databases to track cases to aid diagnosis and treatment.

Vice Adm. Adam Robinson, the Navy surgeon general, told the House Armed Services Subcommittee on Military Personnel on April 13 that the service has generated a spreadsheet for the Marine Corps to record blast injuries. Marines who have suffered three concussions from blasts -- which on the surface might not seem to have caused brain damage -- are required to undergo neurological examination, Robbins told lawmakers at the hearing.

Cmdr. Joseph "Cappy" Surette, spokesman for the Navy Bureau of Medicine and Surgery, said field surgeons use the spreadsheet to identify Marines who have sustained possible battlefield concussions to ensure appropriate evaluations and follow-up care. The spreadsheet also helps identify Marines who sustained a concussion, but did not seek medical care, he added.

In addition, the Marine Corps plans to develop a nonmedical database for field commanders to better identify which of their troops have been exposed to concussive events. The system will be integrated with Navy medical systems to advance the research and treatment of traumatic brain injury, he said.

Air Force Col. Michael Jaffee, director of the Defense and Veterans Brain Injury Center, said there has been a shift in how the Defense Department tracks brain injuries in combat, moving from self-reporting to an incident-based tracking system. The department plans to release a policy on the new approach in the coming months.

Jaffee said Defense aims to merge operational information with medical data in a single database to track and identify traumatic brain injuries. This would take information from a battlefield incident -- such as a mine-resistant ambush protected vehicle hitting a mine -- and correlating it with the personnel on board, along with their medical evaluations.

Such a database, Jaffee said, would help identify personnel who could have sustained a blast injury versus those who sustained injury by hitting their head on the wall of the vehicle.

Defense also uses data compiled by the National Football League to study the effect of impact on the brain, Jaffee said. Football players can experience G forces of 100 Gs from a hit to the head, more than 10 times the force an F-15 fighter pilot experiences coming out of a dive, he said.

Michael Leggieri, director of Defense's Blast Injury Research Program Coordinating Office at the Army Medical Research and Materiel Command at Fort Detrick, Md., is evaluating information from helmet sensors worn by 5,000 soldiers and 2,000 Marines in Iraq and Afghanistan from March 2008 to March 2009.

The Army recorded 600 blast events from internal helmet sensors and more than 500 from external sensors, downloading the data to a secure database for review.

Since combat helmets have padding that partially deflects the blasts, Leggieri said his team could not use raw data from the sensors to conduct the research. Instead, researchers first had to develop an algorithm to filter out the effect of the padding.

The blast injury research center is crunching data from all 7,000 sensors with the help of the algorithm, and Leggieri said he expects to report results to senior Army leaders within a month.