Delayed TBI diagnoses inspire a mission

Delayed TBI diagnoses inspire a mission

By Gregg Zoroya - USA Today
Posted : Thursday Jul 24, 2008 9:05:11 EDT

LANDSTUHL, Germany — It took nearly three years for the Army to understand the damage to Army Sgt. Chad Joiner’s brain after a roadside explosion left him unconscious in a Humvee on June 28, 2005.

He finished his tour and returned home, struggled with headaches and memory loss, went back to Iraq and survived another bombing in February that aggravated his symptoms.

Only after arriving here at the Army’s Landstuhl Regional Medical Center with an ankle injury in February did a new and aggressive screening program finally identify Joiner’s brain injury and lead to treatment.

“I’m just in shock that somebody is figuring out what’s wrong with me,” said Joiner, 26, adding that his gratitude for the treatment outweighs any bitterness over the delay in diagnosing his injury.

The Pentagon debated for years whether to systematically screen troops for brain injuries such as Joiner’s. A recent study by Rand Corp., a research group, said such injuries could have affected 320,000 Iraq and Afghanistan war veterans. Uncertain how aggressively to identify a wound that is still largely a mystery, the Pentagon initially resisted calls to screen all service members coming off the battlefield. Under pressure from Congress, the Pentagon in March ordered all military branches to screen for traumatic brain injury.

By then, doctors at this key Army hospital — through which all war casualties pass on their way home — already had begun to check each of the wounded for a brain injury in an effort that could set new standards for whether such troops ever return to duty.

“One of the things we’ve learned here at Landstuhl is you have to be actively looking for this to find it,” said Col. Stephen Flaherty, who oversees the TBI screening process here.

If there is the slightest indication that a service member is suffering TBI, he or she is almost certain to be kept from returning to combat. During the past six months, only two out of several hundred troops diagnosed with mild TBI have been allowed to return to the war, doctors here said.

The aggressive monitoring developed in Landstuhl could produce valuable information about how best to spot and treat brain injuries, the doctors said.

“If I have a hint of a whiff of a suspicion — no matter how vehemently you want to go back downrange [to Iraq] — that you will be compromised, then I’ve got to be the black hat and say, ‘No, you’re not going back,’” said Maj. Shawna Scully, a neurologist who directs TBI recovery. “I’m sure there are some commanders downrange who are furious with me because I didn’t take X soldier and send them back.”

Before the aggressive screening for brain injuries here, doctors at only a few military sites — most notably, Fort Carson, Colo. — and Department of Veterans Affairs hospitals screened for TBI.

However, a debate is growing within military medicine about mild TBI and aggressive screening efforts.

Army Col. Charles Hoge, a psychiatrist and epidemiologist who has conducted landmark research on post-traumatic stress disorder, published a controversial study in the New England Journal of Medicine this year, arguing that the screening can lead to misdiagnosis. He argued that any lingering symptoms are often the result of PTSD.
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http://www.armytimes.com/news/2008/07/gns_tbi_072408/