INTRODUCTION: Injury Severity Score (ISS) and GCS can be retrospective markers of @entity130 , but if used by clinicians to decide on the treatment of acutely brain-injured casualties at the point of injury may potentially limit interventions on @entity1 who may ultimately survive with good functional outcomes. METHODS: ISS/GCS and long-term outcomes were reviewed by assessing all UK military neurorehabilitation @entity1 with an operational/combat @entity1545 treated over 4   years (February 2008-July 2012) at Defence Medical Rehabilitation Centre (Headley Court). RESULTS: 34 @entity1 from 9 operational tours of Iraq and Afghanistan were analysed. Overall, 44% of @entity130 were due to improvised explosive devices (IEDs) and 41% from gunshot wounds; 70.9% of @entity130 were penetrating wounds with the remainder due to blast/blunt @entity130 or combined injury. The primary injury was head/neck in 76.5%, although eight @entity1 (23.4%) requiring neurorehabilitation were initially 'non-head injury'. Eight @entity1 (26.5%) sustained more than 10 @entity130 , and 18 had between three and nine @entity130 . Eleven @entity1 (32%) had an initial GCS of 3, and 16 (47%) had ISS of 75 (deemed 'unsurvivable'). All @entity1 with ISS of 75 were long-term survivors. At 4   months after discharge, 47% (16) were fully independent, and a further 41% (14) were independent in own homes, but needed assistance with some activities, such as paying bills. Over three-quarters (27 @entity1 , 79%) returned to full/part-time work, 11 of whom returned to military duties; 93% of 'unsurvivable' ISS, and 91% of @entity1 with GCS of 3 were capable of returning/returned to work. In total, 7/11 casualties returning to military duties had major @entity130 , and two were 'unsurvivable'. All seven casualties with both GCS 3 and ISS 75 survived and returned to independence (help with some activities). CONCLUSIONS: ISS/GCS at the point of injury does not reflect eventual outcome. IEDs/gunshots cause the greatest number of @entity130 and the highest incidence of @entity1545 . @entity1545 should be considered in every battlefield casualty, irrespective of whether the head/neck/spinal cord was avoided. ISS should not be considered indicative or predictive of long-term prognosis/quality of life/employability as @entity1545 in this small cohort is both survivable and recoverable. It should not be used as a retrospective guide to alter treatment pathways, as there is poor correlation with long-term outcome. Subsequent neurorehabilitation should always be considered because survival, return to independence and full employment are very likely.

Injury severity at presentation is not associated with long-term vocational outcome in British XXXX .

@entity1 :: ('9606', 'Species') :: ['participants', 'patients', 'people'] @entity1545 :: ('MESH:D020214', 'Disease') :: ['Brain injury', 'brain injury'] @entity130 :: ('MESH:D014947', 'Disease') :: ['injuries', 'trauma ISS', 'trauma', 'injury severity']
@entity1545 :: (MESH:D020214,Disease) :: ['Military brain injury']
