Health Services Research & Development

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QUERI: Enhancing Care for Veterans with Polytrauma and Blast-Related Injuries

January 2012


In this era of modern warfare, U.S. military are sustaining new and complex injuries - the majority of which are blast-related. The mission of the Polytrauma and Blast-Related Injuries (PT/BRI) Quality Enhancement Research Initiative (QUERI) is to promote the successful rehabilitation, psychological adjustment and community re-integration of individuals who have sustained polytrauma and blast-related injuries.

Consistent with VHA's definition, PT/BRI-QUERI defines polytrauma as two or more injuries to physical regions or organ systems, one of which may be life threatening, resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability. It has been estimated that more than 60% of blast injuries result in traumatic brain injury, which has been labeled the "signature injury" in the Global War on Terror. Below is just some of the work being carried out by PT/BRI-QUERI, as investigators strive to improve the health and care of Veterans with polytraumatic injuries.

Screening for Prevalent and "Invisible" Problems

To make certain that Veterans returning from Iraq and Afghanistan with combat-related traumatic brain injury (TBI) receive appropriate healthcare, in April of 2007 VA instituted nationwide TBI screening for all OEF/OIF/OND Veterans that used VA healthcare. PT/BRI-QUERI's highest priority is ensuring that Veterans receive screenings and evaluation for high-frequency "invisible" problems, including:

  • Traumatic brain injury,
  • Post-traumatic stress disorder (PTSD) and other mental illness,
  • Pain, and
  • Sensory loss.

For example, collaborating with VA's Physical Medicine and Rehabilitation Program Office (PM&R PO), investigators from PT/BRI-QUERI carried out and analyzed a survey of providers who had conducted comprehensive TBI evaluations of OEF/OIF/OND Veterans that had screened positive for TBI. Evidence of gaps in provider knowledge identified through this survey then led to the development of a FAQ document on TBI evaluation that is being widely disseminated throughout the VA. Findings also were used to inform polytrauma provider education in a national meeting. Further, PT/BRI investigators are studying the psychometric properties of VA's TBI screening and evaluation tools and are identifying opportunities to improve the TBI screening and evaluation program.

Pain and Mental Health Issues

Pain and mental health issues also are common among Veterans returning from deployment in Iraq and Afghanistan, and these problems may be particularly disabling among VA patients with polytraumatic combat injuries. A recently completed study conducted by PT/BRI-QUERI researchers compared pain and mental health disorders in OEF/OIF/OND Veterans with polytrauma (n=141) and those without polytrauma (n=218). Findings show:

  • Clinically significant pain was the most common problem reported by all Veterans: 87% reported some ongoing pain, and more than 56% reported ongoing clinically significant pain.
  • Although back pain was the most common primary pain, headaches were present in a majority of Veterans and were cited as a source of functional interference.
  • More than 67% of all Veterans met criteria for at least one mental disorder, such as: anxiety disorders, including PTSD, (50%); depressive disorders (45%); substance use disorders (26%); and post-concussional disorder (16%).

Improving Family Support

PT/BRI- QUERI also focuses on improving outcomes for family members of Veterans with TBI/polytrauma. QUERI investigators collaborated with PM&R to develop and implement a tool to help family members understand the rehabilitation experience of Veterans who receive inpatient rehabilitation for more severe TBI/polytrauma. In another project, investigators studied caregivers of Veterans with moderate to severe TBI and learned that they may need additional resources to meet the long-term needs of their injured family member. In addition, preliminary findings indicate that low income levels and the perception of not having a choice about caregiving were the strongest predictors of poor caregiver health outcomes (i.e., depression, caregiver strain, poor self-reported health).

Additional Research for Veterans with Polytraumatic Injuries

PT/BRI-QUERI investigators are conducting other research studies in several key areas of importance to Veterans with polytrauma and blast-related injuries, such as:

Visit the QUERI national website to learn more about this unique quality improvement program with a focus on implementation science, as well as the other nine QUERI Centers.