Acute Management of Mild Traumatic Brain Injury in Military Operational Settings

• - Written background and explanation of the MACE tool, how it is used, how to interpret the scores and how the tool fits with clinician judgment.
• - A video with taped lectures outlining this CPG to include the MACE components, aimed at medical units training for impending deployment.
• - A shorter video, one hour or less, that is developed for the non-medically trained service member to be delivered during a medical threat briefing or similar venue.
• - Discussion of Acute Stress Reaction and TBI overlay as well as dissimilarities of symptoms
• - All pre deployed personnel, including non-medical assets, be briefed on TBI, with a focus on the importance of identification.
• Institute baseline neurocognitive testing
• - High Risk Units (EOD, SOF, ABN) 9
• - Military-wide
• Incorporate different versions of the Standardized Assessment of Concussion (SAC) into the MACE to minimize practice effects on retesting
• Add a Red Flag section to the MACE tool
• Convene subgroup to address comprehensive neuropsychological testing to occur in theatre at Level III
• Further guidance on exertional testing and the use of the Balance Error Scoring System (BESS) is needed.

References

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Acknowledgements: The DVBIC working group would like to acknowledge the following persons for their individual contributions to this product: Jon Gruber, BA; Phil Girard, MS; Dytrea Langon BS; Glenn Parkinson, MSW, MA; and Alice Marie Stevens, M Ed.