Al Asad Missile Exposure TBI and Health Implications STudy (AAMETHIST)
Abstract
Background:Among the 87 U.S. service members (SMs) at Iraq#s Al Asad Airbase who were identified as having had a traumatic brain injury (TBI, or concussion) when Iran fired ballistic missiles into the base, 35 still screened positive upon administration of the Neurobehavioral Symptom Inventory (NSI) and Military Acute Concussion Evaluation 2 (MACE-2) 4 weeks later. The cohort of 35 were then evacuated to Landstuhl Regional Medical Center (LRMC) in Germany for further medical evaluation. Approximately half of those who were sent to LRMC were administered the Brain Gauge®, and at least 8 and perhaps as many as 10 had completed two or more Brain Gauge tests separated in time by several weeks. These results have not yet been analyzed, but could provide some especially valuable data onthe utility of this assessment in the setting of TBI. We have particular interest in exploring this further, since we have found that the Brain Gauge appears to have utility in distinguishing blast exposurefrom controls in our Investigating Training Associated Blast Pathology (INVICTA) study. While INVICTA and other studies have examined blast in military training, which is important, the ability to study those who have received blast exposure from unanticipated enemy missiles is also vital.The Research Problem: There is a need for tests that can rapidly identify those who have experienced a concussion. The identification of a rapid field-deployable test would be particularly valuable for military personnel, since decisions must be made about evacuation vs. return to duty, and there is currently no compelling, practical and reliable assessment that can be conducted by medics in the field. Objectives: Analyze the results of the Brain Gauge and other assessments conducted in the Al Asad TBI cohort to determine: 1) Is the Brain Gauge consistently abnormal in this cohort? 2) Do the Brain Gauge results correlate with scores on the NSI and other assessments conducted in the field? 3) Can the Brain Gauge, and in particular the degree of deviation from normal, be used to estimate the level of blast exposure and/or severity of concussive impact?Technical Approaches: We will analyze the Brain Gauge composite score and each of the 8 component measures upon which it is derived, across this cohort, and will compare them to other available data and assessments. Further, for those who completed more than one Brain Gauge assessment, we will assess changes over time and assess the extent to which they are related to other measures of symptoms and other available knowledge of their exposure. Anticipated Outcomes: While the Brain Gauge appears to have promise as a TBI assessment method, the literature has not been uniformly positive. Most notably, a 2022 report, while finding significant aggregate differences between concussed and control SMs, reported that the sensitivity of the Brain Gauge was fairly low for being able to identify TBI. However, their population was not necessarily aswell defined with regard to their TBI history as the Al Asad cohort, so we have the opportunity to further define the benefit of this assessment. Impact on DoD Capabilities: The Brain Gauge is an easily and rapidly conducted assessment that has the potential to be employed by military medics in the field, and to guide decisions on evacuation and return to duty, which are crucial in maximizing the fighting force while protecting those at risk from further insults which could exacerbate their already injured brains. Thus, if our analyses succeed in documenting utility of the Brain Gauge, it could enhance military readiness, and afford better decision making and better protect some SMs from harm. On the other hand, if we do not find that the Brain Gauge is useful in this population, it would suggest the need to develop other alternatives.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 09, 2024
- Source ID
- N000142412788
Entities
People
- Michael J. Roy
Organizations
- Henry M. Jackson Foundation for the Advancement of Military Medicine
- Office of Naval Research
- United States Navy