DVBIC is the DoD’s Office of Responsibility for tracking TBI data in the U.S. military. Our website provides numbers for service members diagnosed with TBI since 2000, listed in total and identified by service and injury severity. The numbers are updated each quarter.
Information posted here is collected from electronic medical records in cooperation with the Armed Forces Health Surveillance Center.
The numbers represent medical diagnoses of TBI that occurred anywhere U.S. forces are located, including the continental U.S. The diagnosis and severity of injury were determined using ICD-9 codes. Importantly, these numbers are not all deployment-related; over 80% of TBIs occur in a non-deployed setting. Common causes of TBI include crashes in privately owned and military vehicles, falls, sports and recreation activities, and military training.
Frequent visitors to this website may ask whether some of the TBI figures have changed, and they have. Data experts in every field - military or civilian - review and perform quality control checks on the data they gather and use. While members of the military health system were performing quality checks, they found an error in coding that led to inaccurate reporting: a digit transposition made during data entry led to some TBIs being listed as “moderate” rather than “unclassifiable.”
Injuries and illnesses are assigned in both civilian and military medicine are categorized using a system organized by the U.N.’s World Health Organization known as the International Classification of Diseases, ninth edition, or ICD-9. The U.S. military, after assigning an ICD-9 code, further classifies TBIs into the categories of mild, moderate, severe, penetrating or unclassifiable.
This error did not impact the care given to any service members or documentation in any individuals’ medical records; rather, the digit transposition only impacted the military health system’s overall reporting. Every service member who was diagnosed with a TBI has still and/or is still receiving appropriate care. The act of finding and fixing this error has led to the shift of some TBIs being reclassified from “moderate” to “mild TBI (mTBI)” or “unclassifiable.” Said another way, the total number of TBI cases remains the same, but a number of those cases over the years has moved from one column to another.
The vast majority of TBIs sustained by members of the U.S. armed forces is still mild, also known as concussion, and of those service members who sustain an mTBI, most recover and return to duty within seven to 10 days.
Frequently Asked Questions:
- What was the coding error? The ICD-9 code number 854.00, for intracranial injury of other and unspecified nature – unclassifiable, was mistakenly listed as “moderate” rather than “unclassified.”
- Did the coding error impact the health care provided to any service members? No. This was a data error, not a patient care error.
About the Data
New identified cases are added each calendar quarter. To reflect updated medical record information, all TBI numbers, 2000 to most recent quarter, are also retrospectively updated once every year.
Data is provided by the Armed Forces Health Surveillance Center using on the Defense Medical Surveillance System and Theater Medical Data Store.
A case of TBI is defined based on MHS TBI coding guidance (Appendix G: TBI from the Military Health System Coding Guidance: Professional Services and Specialty Coding Guidelines (Version 3.2, effective date 2009/10/01) by the Unified Biostatistical Utility working group) for the first inpatient or outpatient TBI encounter. Individuals with multiple TBI healthcare encounters are included only once. An individual is considered an incident case only once per lifetime.
Severity categories are ranked from more to less severe with the highest level of severity documented determining the severity category classification used for that patient, and the date of their initial TBI medical encounter determines the calendar year in which they are considered an incident case.
Case counts for the current year and immediate past calendar year are updated quarterly. For all other years, case counts are updated annually to reflect changes in medical information.