{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:21:14Z","timestamp":1791814874389,"version":"4.3.4"},"reference-count":68,"publisher":"SAGE Publications","issue":"17-18","license":[{"start":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T00:00:00Z","timestamp":1661385600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>This review examines how lessons learned from United States military conflicts, beginning with the United States Civil War through the engagements in Iraq and Afghanistan, have shaped current traumatic brain injury (TBI) care in the United States military, influenced congressional mandates and directives, and led to best practices in caring for the warfighter. Prior to the most recent war, emphasis was placed on improving the surgical and medical care of service members (SM) with severe and especially penetrating brain injuries. However, during the Iraq and Afghanistan conflicts, also known as the Global War on Terrorism (GWOT), blast injury from improvised explosive devices most often caused mild TBI (mTBI), an injury that was not always recognized and was labelled the \u201csignature wound\u201d of the GWOT. This has led to extensive research on objective diagnostic technologies for mTBI, the association of mTBI with post-traumatic stress disorder (PTSD), and the long term consequences of mTBI. Here we summarize the key findings and most important advances from those efforts, and discuss the way forward regarding future military conflicts.<\/jats:p>","DOI":"10.1089\/neu.2022.0103","type":"journal-article","created":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T06:58:00Z","timestamp":1650610680000},"page":"1133-1145","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":49,"title":["Military Traumatic Brain Injury: The History, Impact, and Future"],"prefix":"10.1177","volume":"39","author":[{"given":"Megan A.","family":"Lindberg","sequence":"first","affiliation":[{"name":"Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA."},{"name":"Credence Management Solutions, LLC, Vienna, Virginia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth M.","family":"Moy Martin","sequence":"additional","affiliation":[{"name":"Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald W.","family":"Marion","sequence":"additional","affiliation":[{"name":"Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA."},{"name":"General Dynamics Information Technology, Fairfax, Virginia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,8,25]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"United States Department of Defense. Department of Defense Instruction Number 6490.11. Policy guidance for management of mild traumatic brain injury\/concussion in the deployed setting. November 26 2019. Available from https:\/\/www.esd.whs.mil\/Portals\/54\/Documents\/DD\/issuances\/dodi\/649011p.pdf. [Last accessed: 3\/25\/2022]."},{"key":"e_1_3_4_3_2","first-page":"S380","article-title":"Concussions and the military: issues specific to service members","author":"Rigg JL","year":"2011","unstructured":"Rigg JL, , Mooney SR. Concussions and the military: issues specific to service members. PM R, 2011;3(10 Suppl. 2):S380\u2013386.","journal-title":"PM R"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-012-0303-6"},{"key":"e_1_3_4_5_2","first-page":"12","article-title":"Neuropathology of traumatic brain injury: comparison of penetrating, nonpenetrating direct impact and explosive blast etiologies","author":"de Lanerolle NC","year":"2015","unstructured":"de Lanerolle NC, , Kim JH, , Bandak FA. Neuropathology of traumatic brain injury: comparison of penetrating, nonpenetrating direct impact and explosive blast etiologies. Semin Neurol, 2015;35(1):12\u201319.","journal-title":"Semin Neurol"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.133.7.783"},{"key":"e_1_3_4_7_2","unstructured":"Weber JW Hassler WW. American-Civil-War. In: Encyclopaedia Britannica 8th ed. Encyclopaedia Britannica: Chicago; 2021. https:\/\/www.britannica.com\/event\/American-Civil-War\/The-military-background-of-the-war (Last accessed May9 2022)."},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-52892-6.00024-6"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.174.5.1741233"},{"key":"e_1_3_4_10_2","doi-asserted-by":"crossref","unstructured":"Cifu DX Cohen SI Lew HL et al. The history and evolution of traumatic brain injury rehabilitation in military service members and veterans. Am J Phys Med Rehabil 2010;89(8):688\u2013694.","DOI":"10.1097\/PHM.0b013e3181e722ad"},{"key":"e_1_3_4_11_2","doi-asserted-by":"crossref","unstructured":"Protas M Yilmaz E Patel AP et al. Review of treatment of gunshot wounds to head in late 19th century. World Neurosurg 2018;116:396-401.","DOI":"10.1016\/j.wneu.2018.04.043"},{"key":"e_1_3_4_12_2","unstructured":"Slater J. Neurosurgery at war. Annual meeting of the Western Neurosurgical Society. Olympic Valley-Lake Taho CA. September 2005."},{"key":"e_1_3_4_13_2","doi-asserted-by":"crossref","unstructured":"Trunkey DD. History and development of trauma care in the United States. Clin Orthop Rel Res. 2000(374):36\u201346.","DOI":"10.1097\/00003086-200005000-00005"},{"key":"e_1_3_4_14_2","doi-asserted-by":"crossref","unstructured":"Kaufman HH. Treatment of head injuries in the American Civil War. J Neurosurg 1993;78(5):838\u2013845.","DOI":"10.3171\/jns.1993.78.5.0838"},{"key":"e_1_3_4_15_2","unstructured":"United States Surgeon-General's Office Barnes JK Woodward JJ et al. The Medical and Surgical History of the War of the Rebellion 1861-1865. Washington DC: Government Printing Office; 1870\u20131888."},{"key":"e_1_3_4_16_2","doi-asserted-by":"crossref","unstructured":"Bollet AJ. Military medicine in the Spanish-American War. Perspect Biol Med 2005;48(2):293\u2013300.","DOI":"10.1353\/pbm.2005.0049"},{"key":"e_1_3_4_17_2","doi-asserted-by":"crossref","unstructured":"Rosengart MR. Critical care medicine: landmarks and legends. Surg Clin North Am 2006;86(6):1305\u20131321.","DOI":"10.1016\/j.suc.2006.09.004"},{"key":"e_1_3_4_18_2","doi-asserted-by":"crossref","unstructured":"Pesce A Palmieri M Frati A et al. A forgotten tale from the Great War: General Lorenzo Bonomo and the birth of Italian war neurosurgery. World Neurosurg 2020;140:338\u2013346.","DOI":"10.1016\/j.wneu.2020.05.113"},{"key":"e_1_3_4_19_2","doi-asserted-by":"crossref","unstructured":"Lanska DJ. Historical perspective: neurological advances from studies of war injuries and illnesses. Ann Neurol 2009;66(4):444\u2013459.","DOI":"10.1002\/ana.21822"},{"key":"e_1_3_4_20_2","doi-asserted-by":"crossref","unstructured":"Lanska DJ. Elaboration of the visual pathways from the study of war-related cranial injuries: the period from the Russo-Japanese War to World War I. Front Neurol Neurosci 2016;38:31\u201342.","DOI":"10.1159\/000442567"},{"key":"e_1_3_4_21_2","unstructured":"Spurling RG Woodhull B. The surgical volumes of the history of the United Stated Army Medical Department in World War II. Neurosurgery. Arch Surg 1960;80:406\u2013415."},{"issue":"6","key":"e_1_3_4_22_2","first-page":"e1342","article-title":"A case-based review of the management of penetrating brain trauma","volume":"9","author":"Milton J","year":"2017","unstructured":"Milton J, , Rugino A, , Narayan K, et al. A case-based review of the management of penetrating brain trauma. Cureus, 2017; 9(6):e1342.","journal-title":"Cureus"},{"key":"e_1_3_4_23_2","doi-asserted-by":"crossref","unstructured":"Shively SB Perl DP. Traumatic brain injury shell shock and posttraumatic stress disorder in the military\u2014past present and future. Journal Head Trauma Rehabil 2012;27(3):234\u2013239.","DOI":"10.1097\/HTR.0b013e318250e9dd"},{"key":"e_1_3_4_24_2","doi-asserted-by":"crossref","unstructured":"Grantham EG Mayfield FH. Dr. Roy Glenwood Spurling 1894-1968. J Neurosurg 1968;28(6):610\u2013612.","DOI":"10.3171\/jns.1968.28.6.0610"},{"key":"e_1_3_4_25_2","doi-asserted-by":"crossref","unstructured":"Rehder R Lohani S Cohen AR. Unsung hero: Donald Darrow Matson's legacy in pediatric neurosurgery. J Neurosurg Pediatr 2015;16(5):483\u2013494.","DOI":"10.3171\/2015.4.PEDS156"},{"key":"e_1_3_4_26_2","unstructured":"Craig WM. Neurosurgery in World War II. U S Armed Forces Med J 1952;3(1):1\u201313."},{"key":"e_1_3_4_27_2","doi-asserted-by":"crossref","unstructured":"Rish BL Dillon JD Caveness WF et al. Evolution of craniotomy as a debridement technique for penetrating craniocerebral injuries. J Neurosurg 1980;53(6):772\u2013775.","DOI":"10.3171\/jns.1980.53.6.0772"},{"key":"e_1_3_4_28_2","doi-asserted-by":"crossref","unstructured":"Medell RJ Waisel DB Eskuri SA et al. Field block for cranial surgery in World War II. Mil Med 1998;163(2):80\u201383.","DOI":"10.1093\/milmed\/163.2.80"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.3171\/2014.1.FOCUS13504"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.3171\/2014.2.FOCUS13552"},{"key":"e_1_3_4_31_2","unstructured":"Spurling RG. Neurosurgery in World War II. Bull U S Army Med Dep 1946;6(6):691\u2013695."},{"key":"e_1_3_4_32_2","doi-asserted-by":"crossref","unstructured":"Stone JL Patel V Bailes JE. Sir Hugh Cairns and World War II British advances in head injury management diffuse brain injury and concussion: an Oxford tale. J Neurosurg 2016;125(5):1301\u20131314.","DOI":"10.3171\/2015.8.JNS142613"},{"key":"e_1_3_4_33_2","doi-asserted-by":"crossref","unstructured":"Hughes JT. Hugh Cairns (1896-1952) and the mobile neurosurgical units of World War II. J Med Biogr 2004;12(1):18\u201324.","DOI":"10.1177\/096777200401200107"},{"key":"e_1_3_4_34_2","doi-asserted-by":"crossref","unstructured":"Baker MS. Military medical advances resulting from the conflict in Korea Part II: historic clinical accomplishments. Mil Med 2012;177(4):430\u2013435.","DOI":"10.7205\/MILMED-D-11-00312"},{"key":"e_1_3_4_35_2","doi-asserted-by":"crossref","unstructured":"Wright D. Commonwealth surgery in the Korean war. Lancet 1956;271(6941):505\u2013509.","DOI":"10.1016\/S0140-6736(56)91987-0"},{"key":"e_1_3_4_36_2","doi-asserted-by":"crossref","unstructured":"Watts JC. War surgery in the Korean campaign. Postgrad Med J 1954;30(339):22\u201329.","DOI":"10.1136\/pgmj.30.339.22"},{"key":"e_1_3_4_37_2","doi-asserted-by":"crossref","unstructured":"Meirowsky AM. Penetrating craniocerebral truma: observations in Korean war. JAMA 1954;154(8):666\u2013669.","DOI":"10.1001\/jama.1954.02940420028008"},{"key":"e_1_3_4_38_2","doi-asserted-by":"crossref","unstructured":"Wallace PB Meirowsky AM. The repair of dural defects by graft. An analysis of 540 penetrating wounds of the brain incurred in the Korean War. Ann Surg 1960;151(2):174\u2013180.","DOI":"10.1097\/00000658-196002000-00004"},{"key":"e_1_3_4_39_2","doi-asserted-by":"crossref","unstructured":"Barr J Montgomery S. Helicopter medical evacuation in the Korean War: did it matter? J Trauma Acute Care Surg 2019;87(1S Suppl 1):S10-s13.","DOI":"10.1097\/TA.0000000000002218"},{"key":"e_1_3_4_40_2","unstructured":"Carey ME Sacco W Merkler J. An analysis of fatal and non-fatal head wounds incurred during combat in Vietnam by U.S. forces. Acta Chir Scand Suppl 1982;508:351\u2013356."},{"key":"e_1_3_4_41_2","unstructured":"Carey ME Young HF Mathis JL. The neurosurgical treatment of craniocerebral missile wounds in Vietnam. Surg Gynecol Obstet 1972;135(3):386\u2013389."},{"key":"e_1_3_4_42_2","doi-asserted-by":"crossref","unstructured":"Eiseman B. Combat casualty management in Vietnam. Journal Trauma. 1967;7(1):53\u201363.","DOI":"10.1097\/00005373-196701000-00006"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2011.00015"},{"key":"e_1_3_4_44_2","doi-asserted-by":"crossref","unstructured":"Hammon WM. Analysis of 2187 consecutive penetrating wounds of the brain from Vietnam. J Neurosurg 1971;34(2 Pt 1):127\u2013131.","DOI":"10.3171\/jns.1971.34.2part1.0127"},{"key":"e_1_3_4_45_2","doi-asserted-by":"crossref","unstructured":"Salazar AM Zitnay GA Warden DL et al. Defense and Veterans Head Injury Program: background and overview. J Head Trauma Rehabil 2000;15(5):1081\u20131091.","DOI":"10.1097\/00001199-200010000-00002"},{"key":"e_1_3_4_46_2","doi-asserted-by":"crossref","unstructured":"Warden D. Military TBI during the Iraq and Afghanistan wars. J Head Trauma Rehabil 2006;21(5):398\u2013402.","DOI":"10.1097\/00001199-200609000-00004"},{"key":"e_1_3_4_47_2","doi-asserted-by":"crossref","unstructured":"Ling G Ecklund JM Bandak FA. Brain injury from explosive blast: description and clinical management. Handb Clin Neurol 2015;127:173\u2013180.","DOI":"10.1016\/B978-0-444-52892-6.00011-8"},{"key":"e_1_3_4_48_2","doi-asserted-by":"crossref","unstructured":"Bell RS Vo AH Neal CJ et al. Military traumatic brain and spinal column injury: a 5-year study of the impact blast and other military grade weaponry on the central nervous system. Journal Trauma. 2009;66(4 Suppl):S104\u2013111.","DOI":"10.1097\/TA.0b013e31819d88c8"},{"key":"e_1_3_4_49_2","doi-asserted-by":"crossref","unstructured":"Weisbrod AB Rodriguez C Bell R et al. Long-term outcomes of combat casualties sustaining penetrating traumatic brain injury. J Trauma Acute Care Surg 2012;73(6):1525\u20131530.","DOI":"10.1097\/TA.0b013e318270e179"},{"key":"e_1_3_4_50_2","doi-asserted-by":"crossref","unstructured":"Ling GS Ecklund JM. Traumatic brain injury in modern war. Curr Opin Anaesthesiol 2011;24(2):124\u2013130.","DOI":"10.1097\/ACO.0b013e32834458da"},{"key":"e_1_3_4_51_2","doi-asserted-by":"crossref","unstructured":"Ling G Bandak F Armonda R et al. Explosive blast neurotrauma. J Neurotrauma 2009;26(6):815\u2013825.","DOI":"10.1089\/neu.2007.0484"},{"key":"e_1_3_4_52_2","doi-asserted-by":"crossref","unstructured":"Brandvold B Levi L Feinsod M et al. Penetrating craniocerebral injuries in the Israeli involvement in the Lebanese conflict 1982-1985. Analysis of a less aggressive surgical approach. J Neurosurg 1990;72(1):15\u201321.","DOI":"10.3171\/jns.1990.72.1.0015"},{"key":"e_1_3_4_53_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.01063"},{"key":"e_1_3_4_54_2","doi-asserted-by":"crossref","unstructured":"Ecker RD Mulligan LP Dirks M et al. Outcomes of 33 patients from the wars in Iraq and Afghanistan undergoing bilateral or bicompartmental craniectomy. J Neurosurg 2011;115(1):124\u2013129.","DOI":"10.3171\/2011.2.JNS101490"},{"key":"e_1_3_4_55_2","doi-asserted-by":"publisher","DOI":"10.3171\/2010.2.FOCUS1022"},{"key":"e_1_3_4_56_2","doi-asserted-by":"publisher","DOI":"10.3171\/2018.9.FOCUS18404"},{"key":"e_1_3_4_57_2","doi-asserted-by":"crossref","unstructured":"Breeze J Bowley DM Harrisson SE et al. Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts. J Neurol Neurosurg Psychiatry 2020;91(4):359\u2013365.","DOI":"10.1136\/jnnp-2019-321723"},{"key":"e_1_3_4_58_2","doi-asserted-by":"crossref","unstructured":"Razumovsky A Tigno T Hochheimer SM et al. Cerebral hemodynamic changes after wartime traumatic brain injury. Acta Neurochir Suppl 2013;115:87\u201390.","DOI":"10.1007\/978-3-7091-1192-5_19"},{"key":"e_1_3_4_59_2","doi-asserted-by":"publisher","DOI":"10.3171\/2010.2.FOCUS09257"},{"key":"e_1_3_4_60_2","doi-asserted-by":"publisher","DOI":"10.3171\/2010.2.FOCUS1025"},{"key":"e_1_3_4_61_2","doi-asserted-by":"crossref","unstructured":"Coughlin DJ Boulter JH Miller CA et al. An endovascular surgery experience in far-forward military healthcare\u2013a case series. Mil Med 2020;185(11\u201312):2183\u20132188.","DOI":"10.1093\/milmed\/usaa219"},{"key":"e_1_3_4_62_2","unstructured":"The Department of Defense Center of Excellence for Trauma. Joint Trauma System History; 2019. Available from https:\/\/jts.amedd.army.mil\/index.cfm\/about\/origins (Last accessed January26 2022)."},{"key":"e_1_3_4_63_2","doi-asserted-by":"crossref","unstructured":"Lew HL Poole JH Vanderploeg RD et al. Program development and defining characteristics of returning military in a VA Polytrauma Network Site. J Rehabil Res Dev 2007;44(7):1027\u20131034.","DOI":"10.1682\/JRRD.2007.05.0073"},{"key":"e_1_3_4_64_2","unstructured":"United States Department of Veterans Affairs. Polytrauma\/TBI System of Care; 2015. Available from: https:\/\/www.polytrauma.va.gov\/system-of-care\/index.asp (Last accessed January27 2022)."},{"key":"e_1_3_4_65_2","doi-asserted-by":"crossref","unstructured":"Denny JW Brown RJ Head MG et al. Allocation of funding into blast injury-related research and blast traumatic brain injury between 2000 and 2019: analysis of global investments from public and philanthropic funders. BMJ Mil Health 2020. [Epub ahead of print].","DOI":"10.2139\/ssrn.3688866"},{"key":"e_1_3_4_66_2","doi-asserted-by":"crossref","unstructured":"Champion HR Holcomb JB Young LA. Injuries from explosions: physics biophysics pathology and required research focus. Journal Trauma 2009;66(5):1468\u20131477.","DOI":"10.1097\/TA.0b013e3181a27e7f"},{"key":"e_1_3_4_67_2","doi-asserted-by":"crossref","unstructured":"Agimi Y Regasa LE Ivins B et al. Role of Department of Defense policies in identifying traumatic brain injuries among deployed US Service Members 2001-2016. Am J Public Health 2018;108(5):683\u2013688.","DOI":"10.2105\/AJPH.2018.304347"},{"key":"e_1_3_4_68_2","unstructured":"Hamilton R . An Army Buddy's Call For Help Sends A Scientist On A Brain Injury Quest . National Public Radio . https:\/\/www.npr.org\/sections\/health-shots\/2016\/06\/08\/480608042\/an-army-buddys-call-for-help-sends-a-scientist-on-brain-injury-quest (Last accessed May9 2022)."},{"key":"e_1_3_4_69_2","unstructured":"Defense Health Agency. History of the NICoE. National Intrepid Center of Excellence (NICoE); 2022. Available from: https:\/\/walterreed.tricare.mil\/Health-Services\/Specialty-Care\/National-Intrepid-Center-of-Excellence-NICoE\/About\/History-of-the-NICoE (Last accessed January28 2022)."}],"container-title":["Journal of Neurotrauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/neu.2022.0103","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/neu.2022.0103","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/neu.2022.0103","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:40:37Z","timestamp":1777675237000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.1089\/neu.2022.0103"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,25]]},"references-count":68,"journal-issue":{"issue":"17-18","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1089\/neu.2022.0103"],"URL":"https:\/\/doi.org\/10.1089\/neu.2022.0103","relation":{},"ISSN":["0897-7151","1557-9042"],"issn-type":[{"value":"0897-7151","type":"print"},{"value":"1557-9042","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,25]]}}}