The 80% Solution of the MACE
Dr. Geoffrey Ling talks about the use of the Military Acute Concussion Exam (MACE) — a simple, standardized tool for first providers. "It's better to have an 80 percent solution now than a 100 percent solution that you never see."
[Dr. Geoffrey Ling] So, the MACE exam or the Military Acute Concussion Evaluation, was really designed based upon two things. One is getting a good history and physical examination of the patient. And the second is actually doing a cognitive test. It has four domains to it: memory, orientation, and the like. And it was based upon the standardized assessment of concussion, the SAC, which was developed actually for professional sports and was used by the NFL. So, when we went to war we didn't expect traumatic brain injury to become prominent, but it did—it just did. And so our system, which was led at the time—for traumatic brain injury by the Defense and Veterans Brain Injury Center, the DVBIC, headed by Deborah Warden and then subsequently by David Jaffe and Jamie Grimes—these are all colonels. Ultimately, what happened was they recognized that there was a need to put something in the hands of these first providers to screen for traumatic brain injury. And so the MACE was a very simple exam. It's only a handful of questions—30-point score but the point is is that it's standardized— every single medic got it, every single medic was able to administer it without a great deal of training, and it was a pretty good screening test. You're right, it's not perfect. It is imperfect. The soldiers and the Marines like to memorize it, so they can game the system so they're not identified as having traumatic brain injury, so we've had to draw up a few different versions of it— kind of like having a 5-deck shoe at Vegas so you can't count the cards. But, the reality is is that we had to get something out. It had to be simple. It had to be effective. This is—fits all of that. Now that we've learned, can we make it better? Certainly, we can make it better. I know there are efforts at the DVBIC trying to make it better. But, I would argue that they did a remarkable job in getting something out as fast as they possibly could. It's better to have an 80% solution that you can put out now than a 100% solution that you'll never see.
Posted on BrainLine January 15, 2013.
Geoffrey Ling, MD, PhD is a program manager at the Defense Advanced Research Projects Agency, where he has responsibility for a broad research portfolio. Dr. Ling is an authority on traumatic brain injury, especially as it pertains to the military.
Produced by Noel Gunther, Ashley Gilleland, and Erica Queen, BrainLine.