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TBI Screening

Screening and Evaluation

After a traumatic event a medical team will look for signs of TBI. A key part of that diagnosis and treatment involves determining how badly the brain is injured.

If a patient loses consciousness, the amount of time that they’re unconscious is important in determining the extent of the brain injury. Usually, the longer the loss of consciousness, the more severe the injury.

In theater, the Military Acute Concussion Evaluation 2 (MACE 2) is a standardized mental status exam that is used to evaluate mild TBI, or concussion. This screening tool was developed to evaluate a person with a suspected concussion, and is used to identify symptoms of a mild TBI.

Future MACE scores can be used to determine if the patient’s cognitive function has improved or worsened over time.

To be most effective, all service members experiencing concussion, or mild traumatic brain injury, should have the MACE 2 administered within the first 24 hours of the event in order to make certain that proper care is administered in a timely fashion. The MACE 2, in combination with a medical exam, can be used to help determine if it is safe for a service member to return to duty.

Another key step in the diagnosis of TBI is a thorough examination of nervous system function, called a neurological exam. Imaging tests of the head such as MRIs, and CT scans can show broken bones, bleeding, swelling and other injuries.

MACE 2: Who gets evaluated for TBIs In-Theater?

Line commanders’ recognition that service members who sustain mild TBIs may not have obvious symptoms and therefore may not seek immediate medical care, led to new guidelines in 2010. Directive-Type Memorandum (DTM) 09-033 requires medical evaluations of all in-theater service members following exposure to possible concussive events.

Covered scenarios include anyone:

  • Who has been in a vehicle that was damaged by a blast
  • Within 50 meters of a blast
  • Within a structure hit by an explosive device
  • Who sustained a direct blow to the head or experienced a loss of consciousness
  • Who is directed to be screened by their command

Under these conditions service members are screened with a MACE 2 and must wait 24 hours to be re-evaluated before resuming duties. Service members who lost consciousness during the event, are also given neurological exams.

Last Updated: February 24, 2021

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