{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:15:06Z","timestamp":1778199306024,"version":"3.51.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3-4","license":[{"start":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T00:00:00Z","timestamp":1730505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,27]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To understand the mechanisms of injury and demographic risk factors associated with traumatic brain injury (TBI) patients among active and reserve service members in the U.S. Military before and during the COVID-10 pandemic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Active and reserve service members diagnosed with an incident TBI from January 2019 through September 2021 were selected. Traumatic brain injury patients diagnosed before March 1, 2020 were categorized as pre-COVID (PC), and patients diagnosed on or after March 1, 2020 were categorized as the intra-COVID (IC) group, aligning closely with the date when the World Health Organization officially proclaimed the pandemic. We determined the frequency of causes of injuries associated with TBI separate by sex, age, occupation, and TBI severity. In addition, we conducted multivariate logistic regression analyses to assess the demographic risk factors associated with TBI severity during the PC and IC eras.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Our cohort included 48,562 TBI patients: 22,819 (47.0%) diagnosed during the PC era and 25,743 (53.0%) diagnosed during the IC era. The major mechanisms of injury within our TBI cohort were being struck by\/against objects, falls\/slips\/trips, and motor vehicle traffic accidents before and during the pandemic. The most common causes of TBI were not impacted by COVID, but motor vehicle accidents did increase during the IC era. The mechanisms of injury associated with TBI differed by TBI severity: being struck by or against an object caused more mild and moderate TBI; motor vehicle accidents caused more severe TBI; and firearms was a major cause of penetrating TBI. In addition, the percentage of severe TBI because of firearms rose sharply during the IC era. Further, women were more likely to be diagnosed with mild TBI compared to men.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Military leaders should consider how different causes of injury are associated with differing TBI severities and how certain demographic groups were vulnerable to specific TBI severities when developing injury prevention programs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae492","type":"journal-article","created":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T16:42:43Z","timestamp":1730565763000},"page":"e830-e837","source":"Crossref","is-referenced-by-count":1,"title":["Mechanisms of Injury for Traumatic Brain Injury Among U.S. Military Service Members Before and During the COVID-19 Pandemic"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8410-2247","authenticated-orcid":false,"given":"Tajrina","family":"Hai","sequence":"first","affiliation":[{"name":"Traumatic Brain Injury Center of Excellence , Silver Spring, MD 20910,","place":["USA"]},{"name":"Compass Government Solutions , Annapolis, MD 21401,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yll","family":"Agimi","sequence":"additional","affiliation":[{"name":"Traumatic Brain Injury Center of Excellence , Silver Spring, MD 20910,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tesfaye","family":"Deressa","sequence":"additional","affiliation":[{"name":"Traumatic Brain Injury Center of Excellence , Silver Spring, MD 20910,","place":["USA"]},{"name":"Compass Government Solutions , Annapolis, MD 21401,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Haddad","sequence":"additional","affiliation":[{"name":"Traumatic Brain Injury Center of Excellence , Silver Spring, MD 20910,","place":["USA"]},{"name":"Compass Government Solutions , Annapolis, MD 21401,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,11,2]]},"reference":[{"key":"2025031111125342400_R1","article-title":"DoD TBI Worldwide Numbers","author":"Traumatic Brain Injury Center of Excellence"},{"key":"2025031111125342400_R2","article-title":"Surveillance Report of Traumatic Brain Injury-related Emergency Department Visits, Hospitalizations, and Deaths","author":"US Centers for Disease Control","year":"2014"},{"issue":"5-6","key":"2025031111125342400_R3","doi-asserted-by":"publisher","first-page":"e233","DOI":"10.1093\/milmed\/usy313","article-title":"Incidence of traumatic brain injury in the U.S. Military, 2010-2014","volume":"184","author":"Agimi","year":"2019","journal-title":"Mil Med"},{"issue":"3","key":"2025031111125342400_R4","first-page":"9","article-title":"External causes of traumatic brain injury, 2000-2011","volume":"20","year":"2013","journal-title":"MSMR"},{"key":"2025031111125342400_R5","article-title":"Coronavirus disease (COVID-19) pandemic","author":"World Health Organization"},{"key":"2025031111125342400_R6","article-title":"Elective surgical, invasive, and dental procedures in miltiary treatment facilities","year":"2020"},{"issue":"9","key":"2025031111125342400_R7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss6609a1","article-title":"Traumatic brain injury-related emergency department visits, hospitalizations, and deaths - United States, 2007 and 2013","volume":"66","author":"Taylor","year":"2017","journal-title":"MMWR Surveill Summ"},{"key":"2025031111125342400_R8","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.wneu.2020.08.083","article-title":"The effects of lockdown during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on neurotrauma-related hospital admissions","volume":"146","author":"Figueroa","year":"2021","journal-title":"World Neurosurg"},{"issue":"1","key":"2025031111125342400_R9","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-85526-6","article-title":"Trends and outcomes for non-elective neurosurgical procedures in Central Europe during the COVID-19 pandemic","volume":"11","author":"Grassner","year":"2021","journal-title":"Sci Rep"},{"issue":"December","key":"2025031111125342400_R10","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.wneu.2021.09.030","article-title":"The impact of the COVID-19 pandemic on traumatic brain injury management: lessons learned over the first year","volume":"156","author":"Lester","year":"2021","journal-title":"World Neurosurg"},{"issue":"12 Suppl 2","key":"2025031111125342400_R11","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000719968.10580.81","article-title":"Increasing traumatic brain injury incidence during COVID-19 pandemic in the emergency department of Cipto Mangunkusumo National General Hospital-a national referral hospital in Indonesia","volume":"95","author":"Prawiroharjo","year":"2020","journal-title":"Neurology"},{"key":"2025031111125342400_R12","article-title":"Surveillance Case Definitions","author":"Armed Forces Health Surveillance Division"},{"issue":"136","key":"2025031111125342400_R13","first-page":"1","article-title":"The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) external cause-of-injury framework for categorizing mechanism and intent of injury","author":"Hedegaard","year":"2019","journal-title":"National Health Statist Rep"},{"key":"2025031111125342400_R14","article-title":"Proposed framework for presenting injury data using ICD-10-CM external cause of injury codes","author":"Annest","year":"2014"},{"issue":"4","key":"2025031111125342400_R15","doi-asserted-by":"publisher","first-page":"E37","DOI":"10.1097\/htr.0000000000000260","article-title":"Epidemiology of isolated versus nonisolated mild traumatic brain injury treated in emergency departments in the United States, 2006-2012: sociodemographic characteristics","volume":"32","author":"Cancelliere","year":"2017","journal-title":"J Head Trauma Rehabil"},{"key":"2025031111125342400_R16","article-title":"Traumatic brain injury-related hospitalizations and deaths by age group, sex, and mechanism of injury: United States 2016\/2017","year":"2021"},{"key":"2025031111125342400_R17","article-title":"COVID-19 Cases in the United States","author":"National Safey Council"},{"issue":"July","key":"2025031111125342400_R18","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2022.106687","article-title":"How did COVID-19 impact driving behaviors and crash severity? A multigroup structural equation modeling","volume":"172","author":"Dong","year":"2022","journal-title":"Accid Anal Prev"},{"issue":"December","key":"2025031111125342400_R19","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2021.106428","article-title":"How did the COVID-19 pandemic affect road crashes and crash outcomes in Alabama?","volume":"163","author":"Adanu","year":"2021","journal-title":"Accid Anal Prev"},{"issue":"April","key":"2025031111125342400_R20","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2023.106988","article-title":"Crash harm before and during the COVID-19 pandemic: evidence for spatial heterogeneity in Tennessee","volume":"183","author":"Patwary","year":"2023","journal-title":"Accid Anal Prev"},{"key":"2025031111125342400_R21","article-title":"2021 was a rough year","author":"Beckman"},{"issue":"11","key":"2025031111125342400_R22","doi-asserted-by":"publisher","first-page":"2299","DOI":"10.1016\/j.joms.2021.06.034","article-title":"Frequency of firearm injuries to head and neck increased during Covid-19 pandemic","volume":"79","author":"Amin","year":"2021","journal-title":"J Oral Maxillofac Surg"},{"issue":"July","key":"2025031111125342400_R23","doi-asserted-by":"publisher","first-page":"e178","DOI":"10.1016\/j.wneu.2021.04.004","article-title":"Impact of coronavirus disease 2019 shutdown on neurotrauma volume in Pennsylvania","volume":"151","author":"Algattas","year":"2021","journal-title":"World Neurosurg"},{"issue":"4","key":"2025031111125342400_R24","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.3046","article-title":"Association of sex and age with mild traumatic brain injury-related symptoms: a TRACK-TBI Study","volume":"4","author":"Levin","year":"2021","journal-title":"JAMA Network Open"},{"issue":"1","key":"2025031111125342400_R25","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-023-01093-4","article-title":"The response of the Military Health System (MHS) to the COVID-19 pandemic: a summary of findings from MHS reviews","volume":"22","author":"Pomer","year":"2024","journal-title":"Health Res Policy Syst"},{"issue":"Supplement_1","key":"2025031111125342400_R26","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1093\/milmed\/usaa410","article-title":"Brain injury: what influences the beliefs U.S. service members have about reporting and seeking care?","volume":"186","author":"Jorgensen-Wagers","year":"2021","journal-title":"Mil Med"},{"issue":"Supplement_1","key":"2025031111125342400_R27","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1093\/milmed\/usz259","article-title":"Traumatic brain injuries: unreported and untreated in an army population","volume":"185","author":"Escolas","year":"2020","journal-title":"Mil Med"},{"issue":"11","key":"2025031111125342400_R28","doi-asserted-by":"publisher","first-page":"801","DOI":"10.14423\/smj.0000000000001463","article-title":"Trends in ICD-10-CM-coded administrative datasets for injury surveillance and research","volume":"115","author":"Costich","year":"2022","journal-title":"Southern Med J"},{"issue":"1","key":"2025031111125342400_R29","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1093\/epirev\/mxr014","article-title":"Classifying external causes of injury: history, current approaches, and future directions","volume":"34","author":"McKenzie","year":"2011","journal-title":"Epidemiol Rev"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/3-4\/e830\/60338340\/usae492.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/3-4\/e830\/60338340\/usae492.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T11:13:30Z","timestamp":1741691610000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/190\/3-4\/e830\/7866810"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,2]]},"references-count":29,"journal-issue":{"issue":"3-4","published-online":{"date-parts":[[2024,11,2]]},"published-print":{"date-parts":[[2025,2,27]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usae492","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,3]]},"published":{"date-parts":[[2024,11,2]]}}}