Center of Innovation on Disability & Rehab Research-GNV
Traumatic Brain Injury in Veterans
Veterans with traumatic brain injury (TBI) differ from civilians with TBI in some key ways—with potentially important implications for long-term care and support of injured service members. New research from the Veterans Administration TBI Model System is presented in the July/August 2017 special issue of the Journal of Head Trauma Rehabilitation (JHTR). The official journal of the Brain Injury Association of America, JHTR is published by Wolters Kluwer.
“The VA TBI Model System is uniquely positioned to inform policy about the health, mental health, socioeconomic, rehabilitation, and caregiver needs following TBI,” write Guest Editors Risa Nakase-Richardson, PhD, of James A. Haley Veterans’ Hospital, Tampa, Fla., and Lillian Stevens, PhD, of Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va. The special issue presents initial reports from a Department of Veterans Affairs (VA)-specific database of patients with all TBI severity levels.
The initial TBI Model System was developed by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) in 1987; 16 civilian hospitals contributed data on the recovery and outcomes for more than 16,000 patients who received inpatient rehabilitation after TBI. The VA TBI Model System, created in response to a Congressional mandate, collects similar data on the rehabilitation outcomes of Veterans with TBI. Since 2010, over 1,000 patients with TBI hospitalized at five regional VA Polytrauma Rehabilitation Centers have been added to the database. The five premier VA Polytrauma Rehabilitation Centers offer inpatient rehabilitation with specialized capacities to treat more severely injured Veterans and active duty service members.
Dr. Nakase-Richardson, site PI of the project and CINDRR investigator, is the lead author of a study comparing the characteristics of 550 patients from the VA TBI Model System versus 5,270 patients from the original NIDILRR system. The results suggested that military and civilian cases of TBI differ in most characteristics and outcomes. The data showed that violent causes of TBI were more common in the VA group, while falls were more common in civilian cases. Most violent causes of TBI in Veterans were related to deployment.
At least 13 percent of the civilian TBI patients had previously served in the military. Dr. Nakase-Richardson and co-authors highlight the need to broaden research findings to Veterans and service members who use primarily civilian health care. The differences between the NIDILRR and the VA databases make it difficult to directly compare outcomes between the military and civilian TBI groups. Further studies could clarify the differences and provide implications for treatment and outcomes.
"Participation in the TBI Model System allows VA to continue to define the unique needs of Veterans following TBI and translate these findings into policy, essentially creating a model of continuous quality improvement for TBI rehabilitation within VA," said Joel Scholten, MD, Director of Physical Medicine and Rehabilitation at the Veterans Health Administration.