Military blast injury in Iraq and Afghanistan: the Veterans Health Administration's polytrauma system of care.

The proportion of veterans cared for by the Veterans Health Administration (VHA) is rapidly shifting to those deriving from the Gulf War, which began in 1990 and the Global War on Terror, which began in 2001. The conflicts in Afghanistan (Operation Enduring Freedom, OEF) and Iraq (Operation Iraqi Freedom, OIF), have produced 1,016,213 veterans; and 454,121 of them have received care through the VHA as of the second quarter of 2009. As of July 31, 2009, 3980 US service members have been killed and almost 35,000 have been wounded in action in OEF/OIF. Explosive blasts have accounted for about 60% of these injuries. Other mechanisms of injury include projectiles (bullets, shrapnel), motor vehicle collisions, falls, and non-combat-related assaults. Service members are surviving combat injuries at much higher rates than in past conflicts and a high percentage of these individuals have traumatic brain injury (TBI) , which has led to TBI’s label as the “signature injury” of OEF/OIF. Estimated rates of TBI in OEF/OIF reported in the media vary widely with some being alarmingly high. However, empirical support for these estimates is limited due to the small sample size, reliance on selfreport data, use of data derived from a single center, and restrictive inclusion criteria. Epidemiological data for injuries in these conflicts continues to develop but a rigorous scientific study of the prevalence of TBI has not been done.