Skip to main content

Military Health System

Concussion Care Pathway Streamlined for Better Results

Image of Dr. Gregory Johnson, Tripler Concussion Clinic medical director, conducts a neurological exam on Army Spc. Andrew Karamatic, a combat medic, having him follow his finger with his eyes, at Tripler Army Medical Center, in Honolulu, Hawaii. Neurologic exams are part of the MACE 2 diagnostic tool to assess service members’ Acute Concussion Care Pathway. (Photo: Army Staff Sgt. Christopher Hubenthal, DMA Pacific – Hawaii Media Bureau). Dr. Gregory Johnson, Tripler Concussion Clinic medical director, conducts a neurological exam on Army Spc. Andrew Karamatic, a combat medic, having him follow his finger with his eyes, at Tripler Army Medical Center, in Honolulu, Hawaii. Neurologic exams are part of the MACE 2 diagnostic tool to assess service members’ Acute Concussion Care Pathway. (Photo: Army Staff Sgt. Christopher Hubenthal, DMA Pacific – Hawaii Media Bureau)

Recommended Content:

Traumatic Brain Injury Center of Excellence

The Defense Health Agency has developed a comprehensive clinical care program to manage concussions based on the military medical community’s many years of experience with injured service members. 

Known as the Acute Concussion Care Pathway, the aim is to provide proactive care immediately after a potential head injury, followed by a standardized process for consistent care until a service member is able to return to duty. 

“It’s no longer ‘come back if you're getting worse,’” Dr. Katharine Stout, assistant branch chief at the Traumatic Brain Injury Center of Excellence, said. “It's, ‘I need to see you back in 72 hours to make sure everything's going in the right direction.’” 

The Acute Concussion Care Pathway evolved from years of research and data about patients with traumatic brain injury, or TBI. The TBICoE consolidated a vast array of information on acute concussion care into a singular pathway for effective care. 

A key component of the program is based on an algorithm that optimizes patient care by evaluating a patient’s symptoms at different stages of care. 

For medical providers, the pathway provides a suite of updated tools to evaluate a patient’s progress, and offers clear steps for service members to return to duty. 

“This is really about performance and not so much about diagnosis,” Navy Capt. (Dr.) Scott Cota, the TBICoE’s branch chief, said. “It's more a performance-based tool and a performance-based process to return individuals to duty through a monitored system.” 

The First Test 

Diagnosis and the initial phase of care can start moments after a concussive event occurs. That could be exposure to a blast or explosion, a vehicle accident, or a sports injury. 

Health care providers in the field can use a screening tool called the Military Acute Concussion Evaluation, or MACE 2, to identify symptoms and diagnose a potential concussion. 

The MACE 2 is a standardized and comprehensive test of brain functions—cognitive, neurological, visual, hearing, balance, and memory. It’s most effective when administered as soon as possible after an injury. 

An early MACE 2 evaluation can reveal critical information that will inform future treatment and improve the likelihood of an effective recovery. 

“We know that early implementation can identify small deficits that could become bigger problems with time, affecting work, family life, and personal satisfaction,” Navy Capt. Duneley Rochino, lead of DHA’s neuromusculoskeletal clinical community, said. “Although it’s more common for patients to be evaluated in an emergency room, a medic or corpsman can perform the initial screening in a field environment, too.”  

A traumatic brain injury is a recoverable yet complex injury with a broad spectrum of symptoms including headaches, memory problems, attention deficits, mood swings, and others. The MACE 2 diagnostic tool allows for health care providers to assess service members more comprehensively after exposure to a concussive event to better determine their care pathway. (Photo: Navy Petty Officer 2nd Cl. Jonathan D. Chandler, Fleet Combat Camera Pacific)
A traumatic brain injury is a recoverable yet complex injury with a broad spectrum of symptoms including headaches, memory problems, attention deficits, mood swings, and others. The MACE 2 diagnostic tool allows for health care providers to assess service members more comprehensively after exposure to a concussive event to better determine their care pathway. (Photo: Navy Petty Officer 2nd Cl. Jonathan D. Chandler, Fleet Combat Camera Pacific) 

Return to Duty

After a service member is diagnosed with a concussion, they should avoid returning to duty too soon. The care pathway provides a tool to determine when it is safe and appropriate to return to work. The standardized evaluation tool for this is known as the Progressive Return to Activity Following Acute Concussion, or PRA.

The TBICoE developed the tool in collaboration with military service branches, an expert working group, and an end user group.

"It's a six-step approach," Cota said. "The PRA starts with resting. Then, there's a gradual increase in activities until they receive clearance to return to full duty or activity."

When a service member initially returns to their unit, they're able to move on to the next stages. That includes specific military activities related to their jobs, Cota said. If they perform those and have no symptoms, then they are cleared to return to full duty.

If an individual doesn't make it through the stages or has persistent symptoms in their PRA stages, they are returned to the previous stage to "restart the process" until they are cleared. If problems persist, doctors can refer them to specialty care.

Goals

Stout said the care pathway and the evaluation tools have been updated in recent years. They are intended to ensure "long-term readiness and avoid long-term consequences of concussion through a standard, acute approach that involves a more proactive follow-up."

Experts emphasize a key component for success is early evaluation using the MACE 2 and using the data to personalize the follow-on care. The pathway initiative makes it easier for caregivers to identify and manage concussions, Rochino said.

"Earlier identification leads to earlier definitive treatment that can prevent further damage that may lead to further medical and behavioral disability," he said.

You also may be interested in...

Head Check: Know Your Helmet, Winter Sports

Fact Sheet
8/6/2020

A Head for the Future aims to raise awareness about TBI among service members, veterans and their families. This fact sheet provides tips for choosing the right helmet for the right sport, with information about different safety features in helmets for skiing, snowboarding and snowmobiling.

Recommended Content:

A Head for the Future | Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Traumatic Brain Injury Center of Excellence | Brain Injury Awareness To Improve Readiness | Winter Safety

Cruise with Control

Fact Sheet
8/6/2020

One of the leading causes of military traumatic brain injury is motor vehicle crashes. This fact sheet provides tips on how to stay safe on motorcycles to help prevent TBI while riding. It also includes the signs and symptoms of TBI, and how to get help if you think you sustained a brain injury.

Recommended Content:

A Head for the Future | Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Traumatic Brain Injury Center of Excellence

2006 DoD Worldwide Numbers for TBI

Publication
8/6/2020

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | TBI Educators | TBI Provider Resources | DOD TBI Worldwide Numbers | Patient and Family Resources | TBICoE Research | A Head for the Future | Armed Forces Health Surveillance Division | Defense Medical Surveillance System | Surveillance Case Definitions | Traumatic Brain Injury Center of Excellence

2005 DoD Worldwide Numbers for TBI

Publication
8/6/2020

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | TBI Educators | TBI Provider Resources | DOD TBI Worldwide Numbers | TBICoE Research | A Head for the Future | Patient and Family Resources | Armed Forces Health Surveillance Division | Defense Medical Surveillance System | Surveillance Case Definitions | Traumatic Brain Injury Center of Excellence

2004 DoD Worldwide Numbers for TBI

Publication
8/6/2020

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | TBI Educators | Patient and Family Resources | TBI Provider Resources | TBICoE Research | A Head for the Future | Armed Forces Health Surveillance Division | Defense Medical Surveillance System | Surveillance Case Definitions | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

2000 DoD Worldwide Numbers for TBI

Publication
8/6/2020

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | TBI Provider Resources | TBICoE Research | A Head for the Future | Defense Medical Surveillance System | Surveillance Case Definitions | Armed Forces Health Surveillance Division

2001 DoD Worldwide Numbers for TBI

Publication
8/6/2020

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | TBI Educators | Patient and Family Resources | TBI Provider Resources | TBICoE Research | A Head for the Future | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Armed Forces Health Surveillance Division | Defense Medical Surveillance System | Surveillance Case Definitions

2002 DoD Worldwide Numbers for TBI

Publication
8/6/2020

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | TBI Educators | Patient and Family Resources | TBI Provider Resources | TBICoE Research | A Head for the Future | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Armed Forces Health Surveillance Division | Defense Medical Surveillance System | Surveillance Case Definitions

2003 DoD Worldwide Numbers for TBI

Publication
8/6/2020

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | TBI Educators | Patient and Family Resources | TBI Provider Resources | TBICoE Research | A Head for the Future | Armed Forces Health Surveillance Division | Defense Medical Surveillance System | Surveillance Case Definitions | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

TBI Hot Topics Bulletin September 2020

Publication
8/4/2020

Are you a busy health care provider? Not enough time to keep up with research? Stay informed with the TBI Hot Topics Bulletin. We track the latest TBI scientific studies, advances, and discoveries most relevant to health care providers. This issue covers the second quarter of calendar year 2020.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | TBI Provider Resources | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

DVBIC Publications 1992-2018

Publication
8/4/2020

DVBIC research publications from 1992-2018.

Recommended Content:

Research and Engineering | Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | TBICoE Research

DVBIC Publications 2019

Publication
8/4/2020

Citation information for 2019 publications of DVBIC research.

Recommended Content:

Research and Engineering | Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Traumatic Brain Injury Center of Excellence | TBICoE Research | TBICoE Research Studies

SCORE Chapter 2

Publication
8/4/2020

Psychoeducational Interventions for Persistent Post-Concussion Symptoms Following Combat-Related Mild TBI Chapter two summarizes the psychoeducational interventions used for the control group in the first SCORE treatment arm (SCORE Arm 1). This educational material has been specifically adapted for use with service members and veterans who experience a more chronic course of symptoms following combat-related concussion. Section one explains the background of psychoeducation in the treatment of mild TBI, and section two provides the psychoeducational tool, called the client’s guide to recovery.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | TBI Provider Resources

TBICoE Research Review: Multiple TBI/Multiple Concussion

Publication
8/4/2020

Prior history of TBI may predispose an individual to increased risk of subsequent TBI, which may result from less force, and lengthier recovery from post-injury symptoms. Activities such as contact sports and military service carry particular risk for multiple TBI. In addition to acute post-injury difficulties, cumulative TBI may increase the risk of chronic cognitive and functional impairment. Conservative management of post-injury symptoms as part of a medically monitored, progressive plan for returning to activities is recommended for individuals with a history of TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | TBICoE Research

SCORE Chapter 3

Publication
8/4/2020

Computerized Cognitive Rehabilitation Interventions for Persistent Symptoms Mild TBI Chapter three describes the computerized cognitive rehabilitation interventions used in the second SCORE treatment arm (SCORE Arm 2).

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | TBI Provider Resources
<< < ... 6 7 8 9 10  ... > >> 
Showing results 136 - 150 Page 10 of 17
Refine your search
Last Updated: September 01, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery