The Clinical Standards for Mild TBI Management and Treatment in the US Military Health System

CHAIR

Saafan Malik

PRESENTERS

• Katherine Helmick
• Katharine Stout
• Louis French

DESCRIPTION

Over 340,000 U.S. Service members have been diagnosed with traumatic brain injury (TBI) since 2000. Since 2009 the US Department of Defense has developed and revised one major Clinical Practice Guideline (CPG),12 clinical recommendations (CRs) and clinical support tools. These clinical support tools include the Military Acute Concussion Evaluation (MACE) and the Concussion Management Algorithm (CMA) relating to the treatment of mild Traumatic Brain Injury ( mTBI) in US Service Members. The Defense and Veterans Brain Injury Center (DVBIC), is the DoD’s Center of Excellence for TBI and the manager of the TBI Pathway of Care and Clinical recommendations. The development of CRs provides evidence based standardized guidance for symptom management and treatment recommendations following TBI. This presentation will review the management and treatment of concussion in the US Military Health System from acute battlefield care of mTBI patients to in-garrison mTBI management by primary care teams and the pathways of care for dealing with chronic issues related to concussion including the National Intrepid Center of Excellence (NICoE) model. Topics covered will include the review of the content and use of MACE and CMA in the deployed setting, review of mTBI CPG and selected CR’s including Headache, Neuroendocrine Dysfunction and Progressive Return to Activity. The DoD and DVBIC utilize a standardized process modeled after Institutes of Medicine (IOM) and World Health organization (WHO) recommendations for the development of evidenced based clinical recommendations. Included within the DVBIC process are unique modifications that address the needs and requirements of our military stakeholders including the operational challenges of the deployed setting. The identification of the need for TBI guidance within the MHS, the consideration of Service-specific and Department of Defense Policy are integrated within an evidenced based, systematic process. Additionally, the end user and stakeholders’ preference for delivery is also important to successful implementation. The DVBIC CR development process includes the main steps as defined by the IOM: (1) define a clinical problem, (2) develop systematic reviews, (3) assemble a working group to develop clinical recommendations through appraisal of evidence and incorporate expert opinion, patient preferences and characteristics, and (4) use the guidance to make better informed decisions to improve health outcomes. The CR working groups include representation from all Services and key Government agencies as well as subject matter experts from the civilian-non government sector. The draft documents are further vetted internationally through all Services prior to completion. Education professionals, agencies and organizations who develop clinical practice guidelines and evidenced based best practice clinical recommendations, may benefit from this presentation.

LEARNING OBJECTIVES

• Describe Department of Defense clinical support tools (including the MACE and CMA) for the assessment, management and treatment of mild traumatic brain injury in the deployed setting.
• State the currently available DVBIC Clinical Recommendations related to the management and treatment of service members with traumatic brain injuries.
• Explain the key components of the Department of Defense interdisciplinary care model for the management and treatment of the acute and chronic sequel of mild traumatic brain injury.