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Publication Briefs

Study Examines Prevalence of "Polytrauma Triad" among Iraq and Afghanistan War Veterans

Prior studies have identified traumatic brain injury (TBI), PTSD, and pain to be the major comorbid elements most frequently seen in military personnel previously deployed to Iraq and Afghanistan, who return with polytrauma. This constellation of comorbidities has been referred to as the "polytrauma triad." This study sought to determine the prevalence of TBI, PTSD, and pain among Veterans from the OEF/OIF/OND wars, who received VA healthcare. Using VA data, investigators identified all OEF/OIF/OND Veterans who accessed VA care at least once from FY09 through FY11 (n=613,391). Because VA requires that all Veterans returning from Iraq and/or Afghanistan be screened for deployment-related TBI, as well as PTSD, investigators also identified a subset of Veterans who were diagnosed with TBI, PTSD, and/or common head, neck, or back pain.


  • Large and increasing numbers of OEF/OIF/OND Veterans accessed the VA healthcare system over the three-year study period. Of these Veterans, about 10% (n=58,885) were diagnosed with TBI, 30% (n=179,723) with PTSD, and 40% (n=246,883) with pain. Approximately 6% (n=36,800) had all three diagnoses — or the polytrauma triad.
  • Overall, while the absolute number of OEF/OIF/OND Veterans increased by more than 40% from FY09 through FY11, the relative proportion of Veterans diagnosed with TBI, and the high rate of comorbid PTSD and pain in this population have remained stable.


  • Investigators did not examine all possible TBI-related comorbidiities, but focused on mental health and select pain-related problems within the polytrauma triad.
  • These findings are based on administrative data.
  • Data were not available for diagnoses of OEF/OIF/OND Veterans who did not use VA healthcare.

This study was funded through VA/HSR&D's Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative (PT/BRI-QUERI). Drs. Sayer and Scholten lead PT/BRI-QUERI. Drs. Sayer and Taylor, and Ms. Hagel-Campbell are part of HSR&D's Center for Chronic Disease Outcomes Research, Minneapolis, MN.

PubMed Logo Cifu D, Taylor B, Carne W, Bidelspach D, Sayer N, Scholten J, and Hagel-Campbell E. TBI, PTSD, and Pain Diagnoses in OEF/OIF/OND Veterans. Journal of Rehabilitation Research & Development January 2014;50(9):1169-76.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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