Department of Defense: Use of Neurocognitive Assessment Tools in Post-Deployment Identification of Mild Traumatic Brain Injury Page: 1 of 13
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Accountability * Integrity * Reliability
United States Government Accountability Office
Washington, DC 20548
October 24, 2011
Subject: Department of Defense: Use of Neurocognitive Assessment Tools in Post-
Deployment Identification of Mild Traumatic Brain Injury
Traumatic brain injury (TBI) has emerged as a serious concern among U.S. forces
serving in military operations in Afghanistan and Iraq. The widespread use of
improvised explosive devices in these conflicts increases the likelihood that
servicemembers will sustain a TBI, which the Department of Defense (DOD) defines
as a traumatically induced structural injury and/or physiological disruption of brain
function as a result of an external force.1 TBI cases within DOD are generally
classified as mild, moderate, severe, or penetrating. From 2000 to March 2011 there
were a total of 212,742 TBI cases reported by the Defense and Veterans Brain Injury
Center within DOD. A majority of these cases, 163,181, were classified as mild
traumatic brain injuries (mTBI)-commonly referred to as concussions.2
Early detection of injury is critical in TBI patient management. Diagnosis of moderate
and severe TBI usually occurs in a timely manner due to the obvious and visible
nature of the head injury. Identification of mTBI presents a challenge due to its less
obvious nature. With mTBI, there may be no observable head injury. In addition, in
the combat theater, an mTBI may not be identified if it occurs at the same time as
other combat injuries that are more visible or life-threatening, such as orthopedic
injuries or open wounds. Furthermore, some of the symptoms of mTBI-such as
irritability and insomnia-are similar to those associated with other conditions, such
as post-traumatic stress disorder.
Although the majority of patients with mTBI recover quickly with minimal intervention,
a subset of patients develops lingering symptoms that interfere with social and
occupational functioning. Accurate and timely identification of mTBI is important as
treatment can mitigate the physical, emotional, and cognitive effects of the injury.
Neurocognitive deficits associated with mTBI can be identified by neurocognitive
assessment tools. These tools generally consist of a series of tests that measure
1 Department of Veterans Affairs/DOD, Clinical Practice Guideline for Management of Concussion/mild Traumatic
Brain Injury (April 2009).
2DOD specifies that a person may be designated as having an mTBI only if the severity of the injury does not
include: (1) loss of consciousness that lasted longer than 30 minutes; (2) alteration of consciousness for more
than 24 hours; (3) post-traumatic amnesia lasting longer than 24 hours; or (4) an initial score of less than 13 on
the Glasgow Coma Score, a widely-used 15-point scoring system for assessing coma and impaired
consciousness. (Higher scores indicate a less severe injury while lower scores indicate a more severe injury.)
GAO-12-27R DOD Mild Traumatic Brain Injury
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United States. Government Accountability Office. Department of Defense: Use of Neurocognitive Assessment Tools in Post-Deployment Identification of Mild Traumatic Brain Injury, text, October 24, 2011; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc302484/m1/1/: accessed December 17, 2017), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.