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...

Healthy Sleep Following Concussion/mTBI Fact Sheet

Fact Sheet
11/16/2022

Getting restful sleep is one of the most important things you can do for your health, and it often takes thoughtful preparation during the day. This fact sheet offers service members and veterans who experience sleep disturbances after a concussion with healthy sleep tips that can likely improve sleep.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | TBI Provider Resources | Centers of Excellence

2022 (Q2) DOD Worldwide Numbers for TBI

Report
11/9/2022

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the calendar year 2022 through the second quarter. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | TBI Provider Resources | TBI Educators | TBICoE Research | Armed Forces Health Surveillance Division

2000-2022 Q2 DOD Worldwide Numbers for TBI

Report
11/9/2022

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the second quarter of 2022. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | TBI Provider Resources | TBI Educators | TBICoE Research | Armed Forces Health Surveillance Division

2021 DOD Worldwide Numbers for TBI

Report
11/9/2022

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | TBI Provider Resources | DOD TBI Worldwide Numbers

Groundbreaking Study on Trauma-related Sleep Disorder

Article
10/17/2022
Airman with elecronic trackers on his head seen in profile for a sleep disorder study on TSD.

Army researchers publish an important new study on Trauma-associated Sleep Disorder, or TSD.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Sleep

Top U.S. Military Enlisted Leader Shares Experience of Stigma Surrounding TBI

Article
9/30/2022
A man wearing headphones in front of his computer

Recovery after brain injury keeps warfighters mission-ready.

Recommended Content:

Traumatic Brain Injury Center of Excellence

On National Concussion Awareness Day, Learn the Truth about TBI

Article
9/16/2022
A mountain biker wearing a helmet bikes through hard terrain.

Separate the myths and truths around TBI

Recommended Content:

Traumatic Brain Injury Center of Excellence

Neuroendocrine Dysfunction Following Concussion/Mild TBI Provider Fact Sheet

Fact Sheet
9/14/2022

The Neuroendocrine Dysfunction Following Concussion/Mild TBI Provider Fact Sheet, developed by TBICoE, is a one page document that gives primary care managers (PCMs) an overview of neuroendocrine dysfunction (NED) that can occur after concussion, or mild TBI. It highlights conditions with overlapping symptoms, screening and treatment considerations, risk factors, and referral guidance for suspected NED.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources

DOD TBI Worldwide Numbers At-A-Glance

Publication
8/24/2022

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. The "DOD TBI Numbers At-A-Glance" provide a high level overview of TBI's sustained since 2000 and also show the data by severity and service branch.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers

2022 (Q1) DOD Worldwide Numbers for TBI

Report
8/24/2022

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the first quarter of calendar year 2022.

Recommended Content:

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

2000-2022 (Q1) DOD Worldwide Numbers for TBI

Report
8/24/2022

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the first quarter of 2022. The data is also broken down by each branch of the armed services.

Recommended Content:

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

Interview with the SEAC: TBI from a Joint Perspective

Video
7/18/2022
Interview with the SEAC: TBI from a Joint Perspective

In this episode of Picking Your Brain, Traumatic Brain Injury Center of Excellence Branch Chief Capt. Scott Cota and clinical moderator Amanda Gano interview the Senior Enlisted Advisor to the Chairman of the Joint Chiefs of Staff (SEAC), Ramón Colón-López. The discussion covers the health impacts of TBI and blast-related concussion stemming from the demands of combat and training. The SEAC also addresses the importance of maintaining medical readiness through education and military leadership. Listen to more Picking Your Brain episodes at www.health.mil/TBIPodcasts, on DVIDS, or wherever you listen to podcasts.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Podcasts | TBI Provider Resources | Patient and Family Resources | TBI Educators | Centers of Excellence | Traumatic Brain Injury Center of Excellence

Talking to Your Child about TBI: A Guide for Caregivers of Service Members and Veterans

Fact Sheet
6/8/2022

This TBICoE fact sheet includes age-appropriate strategies adults can use to speak with children about traumatic brain injury—or concussion. It also includes tips on how to help kids cope with changes that impact the family unit.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators

Addressing Family Needs: A Guide for Caregivers of Service Members and Veterans

Fact Sheet
6/8/2022

This TBICoE fact sheet includes ways to build stronger family ties and develop coping strategies for challenges the family may experience after a loved one sustains a concussion—or TBI—such as substance misuse, psychological and emotional trauma, and financial changes.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators

Taking Care of Yourself: A Guide for Caregivers of Service Members and Veterans

Fact Sheet
6/8/2022

This TBICoE fact sheet is directed towards caregivers and provides self-care strategies to avoid caregiver burnout and fatigue when caring for a loved one who has sustained a traumatic brain injury.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | Psychological Health Center of Excellence
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 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