Traumatic Brain Injury in the War Zone
http://www.100md.com
《新英格兰医药杂志》
To the Editor: In Okie's Perspective article (May 19 issue)1 on traumatic brain injury (TBI) from the war in Iraq, she alludes to mood disorders that result from such injuries. Patients with TBI have been described as the "walking wounded"2 owing to their lingering neuropsychological problems. Lishman studied 670 cases of head injuries from the Second World War and reported that "simple measures of the amount of brain damage . . . were indeed related to the amount of psychiatric disability encountered one to five years later."3 As many as 77 percent of patients with TBI have been given a diagnosis of depression.4 Mood disorders may result in the restriction of social contact as well as increased loneliness and are major barriers to functional and social rehabilitation.5
Technological improvements and better emergency medical care have reduced the incidence of severe TBI while increasing the numbers of patients with mild or moderate TBI. Such patients are more adversely affected by their emotional problems than by their residual physical disabilities.6 It is important to screen these patients for depression and to conduct neuropsychological testing soon after head injury in order to facilitate treatment and reentry into the community, as well as to optimize the long-term outcome.
Rohit R. Das, M.B., B.S., M.P.H.
Boston Medical Center
Boston, MA 02118
rohit.das@bmc.org
Ranjani N. Moorthi, M.B., B.S., M.P.H.
Saint Vincent Hospital
Worcester, MA 01608
References
Rao V, Lyketsos C. Neuropsychiatric sequelae of traumatic brain injury. Psychosomatics 2000;41:95-103.
Lishman WA. The psychiatric sequelae of head injury: a review. Psychol Med 1973;3:304-318.
Kreutzer JS, Seel RT, Gourley E. The prevalence and symptom rates of depression after traumatic brain injury: a comprehensive examination. Brain Inj 2001;15:563-576.
Morton MV, Wehman P. Psychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations. Brain Inj 1995;9:81-92.
Satz P, Fourney DL, Zaucha K, et al. Depression, cognition, and functional correlates of recovery outcome after traumatic brain injury. Brain Inj 1998;12:537-553.
To the Editor: Although Okie's article described well many of the issues involved in the current war in Iraq, we would like to clarify our comments, reported in the article, regarding the classification of mild TBI. We noted that the boundary between mild and moderate TBI is one hour of loss of consciousness and that the cutoff between moderate and severe TBI is one day of loss of consciousness. However, there is variation in the classification of mild TBI.
Some authors1 use 30 minutes of loss of consciousness as the criterion, and others 20 minutes,2 and still others3 define "brief" loss of consciousness as lasting less than 1 hour. In practice, we more often use the duration of post-traumatic amnesia to determine the level of severity, since that information is available to us more often than are data on loss of consciousness.
Deborah L. Warden, M.D.
Louis French, Psy.D.
Defense and Veterans Brain Injury Center
Washington, DC 20307
References
American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:86-87.
Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery 1981;9:221-228.
International classification of diseases, hospital edition, 9th rev., clinical modification: ICD-9-CM. 6th ed. Vol. 1, 2 & 3. Los Angeles: Practice Management Information Corporation, 2002.
Technological improvements and better emergency medical care have reduced the incidence of severe TBI while increasing the numbers of patients with mild or moderate TBI. Such patients are more adversely affected by their emotional problems than by their residual physical disabilities.6 It is important to screen these patients for depression and to conduct neuropsychological testing soon after head injury in order to facilitate treatment and reentry into the community, as well as to optimize the long-term outcome.
Rohit R. Das, M.B., B.S., M.P.H.
Boston Medical Center
Boston, MA 02118
rohit.das@bmc.org
Ranjani N. Moorthi, M.B., B.S., M.P.H.
Saint Vincent Hospital
Worcester, MA 01608
References
Rao V, Lyketsos C. Neuropsychiatric sequelae of traumatic brain injury. Psychosomatics 2000;41:95-103.
Lishman WA. The psychiatric sequelae of head injury: a review. Psychol Med 1973;3:304-318.
Kreutzer JS, Seel RT, Gourley E. The prevalence and symptom rates of depression after traumatic brain injury: a comprehensive examination. Brain Inj 2001;15:563-576.
Morton MV, Wehman P. Psychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations. Brain Inj 1995;9:81-92.
Satz P, Fourney DL, Zaucha K, et al. Depression, cognition, and functional correlates of recovery outcome after traumatic brain injury. Brain Inj 1998;12:537-553.
To the Editor: Although Okie's article described well many of the issues involved in the current war in Iraq, we would like to clarify our comments, reported in the article, regarding the classification of mild TBI. We noted that the boundary between mild and moderate TBI is one hour of loss of consciousness and that the cutoff between moderate and severe TBI is one day of loss of consciousness. However, there is variation in the classification of mild TBI.
Some authors1 use 30 minutes of loss of consciousness as the criterion, and others 20 minutes,2 and still others3 define "brief" loss of consciousness as lasting less than 1 hour. In practice, we more often use the duration of post-traumatic amnesia to determine the level of severity, since that information is available to us more often than are data on loss of consciousness.
Deborah L. Warden, M.D.
Louis French, Psy.D.
Defense and Veterans Brain Injury Center
Washington, DC 20307
References
American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:86-87.
Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery 1981;9:221-228.
International classification of diseases, hospital edition, 9th rev., clinical modification: ICD-9-CM. 6th ed. Vol. 1, 2 & 3. Los Angeles: Practice Management Information Corporation, 2002.