Functional Status after Blast-Plus-Impact Complex Concussive Traumatic Brain Injury in Evacuated United States Military Personnel

Abstract

Fundamental questions remain unanswered about the longitudinal impact of blast-plus-impact complex traumatic brain injuries (TBI) from wars in Iraq and Afghanistan. This prospective, observational study investigated measures of clinical outcome in US military personnel evacuated to Landstuhl Regional Medical Center (LRMC) in Germany after such blast-plus concussive TBIs. Glasgow Outcome Scale-Extended assessments completed 6 12 months after injury indicated a moderate overall disability in 41/47 (87%) blast-plus TBI subjects and a substantial but smaller number (11/18, 61%, p = 0.018) of demographically similar US military controls without TBI evacuated for other medical reasons. Cognitive function assessed with a neuropsychological test battery was not different between blast-plus TBI subjects and controls; performance of both groups was generally in the normal range. No subject was found to have focal neurological deficits. However, 29/47 (57%) of blast-plus subjects with TBI met all criteria for post-traumatic stress disorder (PTSD) versus 5/18 (28%) of controls ( p = 0.014). PTSD was highly associated with overall disability; 31/34 patients with PTSD versus 19/31 patients who did not meet full PTSD criteria had moderate to severe disability ( p = 0.0003). Symptoms of depression were also more severe in the TBI group ( p = 0.05), and highly correlated with PTSD severity (r = 0.86, p < 0.0001). Thus, in summary, high rates of PTSD and depression but not cognitive impairment or focal neurological deficits were observed 6 12 months after concussive blast-plus-impact complex TBI. Overall disability was substantially greater than typically reported in civilian non-blast concussive ( mild ) patients with TBI, even with polytrauma. The relationship between these clinical outcomes and specific blast-related aspects of brain injuries versus other combatrelated factors remains unknown.

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Document Details

Document Type
Technical Report
Publication Date
Jan 01, 2014
Accession Number
ADA599587

Entities

People

  • Ann M. Johnson
  • Christine L. Macdonald
  • David L. Brody
  • Elliot C. Nelson
  • Nicole J. Werner
  • Raymond Fang
  • Stephen F. Flaherty

Organizations

  • University of Washington

Tags

Communities of Interest

  • Biomedical

DTIC Thesaurus Topics

  • Anxiety Disorders
  • Blast Injuries
  • Brain Injuries
  • Cognitive Impairment
  • Department Of Defense
  • Diseases And Disorders
  • Education
  • Explosive Devices
  • Health Services
  • Medical Personnel
  • Mental Disorders
  • Military Personnel
  • Psychological Tests
  • Sleep Deprivation
  • Students
  • Traumatic Stress Disorder
  • United States

Fields of Study

  • Medicine
  • Psychology

Readers

  • Mental Health of Military Veterans with Posttraumatic Stress Disorder (PTSD): Risk Factors, Prevalence, Symptoms, and Treatment.
  • Neurotrauma and Rehabilitation Medicine.