Traumatic brain injury (TBI) is a considerable problem for the military worldwide, and the media have designated it the ‘signature injury’ of the conflicts in Afghanistan and Iraq . It can occur following head trauma after a direct impact or from being in close proximity to a blast. TBI can have different forms depending on the extent of the injury; this editorial will focus on TBIs that result in brain hemorrhage. On the battlefield, it is likely to be overlooked in favor of more readily visible injuries, yet bleeding and inflammation within the head can cause death or pervasive ongoing psychiatric conditions.
TBI affects mainly ground-based troops coming into contact with explosions, with more than 4% of those serving in the US military being diagnosed with TBI each year . Most were seen in the army and Marine Corps, and approximately 77% of TBIs were ‘mild’. Similarly, a study looking at a sample of UK servicemen and women deployed in Afghanistan found a TBI rate of 2.1% in front line combat personnel and a 1-year incidence rate of 3.2% overall . However, these figures are likely to be the tip of the iceberg as many service members are undoubtedly going undiagnosed with mild TBI that has the potential to lead to serious long-term health and socioeconomic consequences . Ongoing symptoms include a range of physical, cognitive and emotional effects, often persisting long-term and resulting in unemployment, relationship difficulties and reduction of independence. The effects vary depending on the severity of injury, the brain area affected and whether it is a lone or repeat injury: there is evidence that multiple TBIs have a cumulative impact .
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