FIGURE 2.7 Brief Traumatic Brain Injury Screen.

SOURCE: DVBIC, 2007. Reprinted with permission from Lippincott Williams and Wilkins, 2008.

The Military Acute Concussion Evaluation (MACE) has been developed by the DVBIC as a tool for determining cognitive deficits due to mild TBI (DVBIC, 2006a, 2006b). The major goals of the MACE are to confirm the diagnosis of mild TBI, and to provide further assessment data by using the Standardized Assessment of Concussion (McCrea et al., 1997), to record neurocognitive deficits. The MACE can be easily used by medics and corpsmen and can be administered within 5 minutes. The four cognitive domains tested are orientation, immediate memory, concentration, and delayed recall. The MACE is recommended for use in military theater at levels I, II, and III. It is recommended that beyond the use of the MACE other neurocognitive measures be implemented at level III to evaluate the cognitive state of an injured service member comprehensively.

Because moderate, moderate-to-severe, and severe BINTs are often part of complex polytrauma, proper diagnosis of BINT should include both classification of blast injuries and severity scoring of the head injury. The most recent version of the AIS (AIS, 2005) (Gennarelli and Wodzin, 2006) incorporates blast injuries and is regularly used by the US Army; the global scoring of all injuries can be accomplished with that scoring system. In hospitals calculation of the modified PSS SII (Yelverton, 1996; Cernak et al., 1999b) can give additional information that might be valuable for treatment strategies and outcome prediction. A combination of head AIS, as an anatomic measure, and the GCS, as a physiologic measure of brain-injury severity, is useful for initial estimation of brain damage.