Postconcussive Symptoms After Blast and Nonblast-Related Mild Traumatic Brain Injuries in Afghanistan and Iraq War Veterans

Lippa, Sara M.; Pastorek, Nicholas J.; Benge, Jared F.; Thornton, Gabriel

doi:10.1017/s1355617710000743

Cited by 110 publications

(89 citation statements)

References 46 publications

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“…Like Lippa and colleagues [62], we did not find support for any one etiology of injury (blast or nonblast) being more significant for reporting MSI symptoms. Instead, frequency of injury seemed to be a major contributor.…”

Section: Discussioncontrasting

confidence: 66%

“…PTSD and depression have been well documented in OIF/OEF veterans [6,23,[48][49][59][60][61][62][63][64][65][66][67]. This is a notable finding because other studies have found diminished effects of TBI when PTSD and depressive symptom severity were taken into account [6,62]. A major difference between these studies and the present results is our outcome variable: concurrent auditory, visual, and vestibular symptoms reported to cause at least moderate impairment.…”

Section: Discussioncontrasting

confidence: 50%

“…When entered into the same model simultaneously along with other factors, each remained a significant predictor, with mTBI history the most robust. PTSD and depression have been well documented in OIF/OEF veterans [6,23,[48][49][59][60][61][62][63][64][65][66][67]. This is a notable finding because other studies have found diminished effects of TBI when PTSD and depressive symptom severity were taken into account [6,62].…”

Section: Discussionmentioning

confidence: 97%

“…However, without more detail about the nature, timing, and severity of the injuries, these hypotheses are simple conjecture. As Lippa and colleagues offer [62], the effects of blast versus nonblast injuries may be more similar than they are different.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the degree of symptom overlap between TBI and psychiatric disorders [46,61,[63][64]66,[76][77][78][79][80], clinicians evaluating TBI also should determine whether mental health conditions are present to decide on the best course of treatment [6,62]. Patients with MSI may benefit from a team-based approach to care [63][64][77][78].…”

Section: Discussionmentioning

confidence: 99%

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Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Pogoda¹,

Hendricks²,

Iverson³

et al. 2012

JRRD

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Abstract-With the use of Veterans Health Administration and Department of Defense databases of veterans who completed a Department of Veterans Affairs comprehensive traumatic brain injury (TBI) evaluation, the objectives of this study were to (1) identify the co-occurrence of self-reported auditory, visual, and vestibular impairment, referred to as multisensory impairment (MSI), and (2) examine demographic, deployment-related, and mental health characteristics that were potentially predictive of MSI. Our sample included 13,746 veterans with either a history of deployment-related mild TBI (mTBI) (n = 9,998) or no history of TBI (n = 3,748). The percentage of MSI across the sample was 13.9%, but was 17.4% in a subsample with mTBI history that experienced both nonblast and blast injuries. The factors that were significantly predictive of reporting MSI were older age, being female, lower rank, and etiology of injury. Deployment-related mTBI history, posttraumatic stress disorder, and depression were also significantly predictive of reporting MSI, with mTBI history the most robust after adjusting for these conditions. A better comprehension of impairments incurred by deployed servicemembers is needed to fully understand the spectrum of blast and nonblast dysfunction and may allow for more targeted interventions to be developed to address these issues.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Pogoda¹,

Hendricks²,

Iverson³

et al. 2012

JRRD

View full text Add to dashboard Cite

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Association Between 5-Year Clinical Outcome in Patients With Nonmedically Evacuated Mild Blast Traumatic Brain Injury and Clinical Measures Collected Within 7 Days Postinjury in Combat

et al. 2019

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Key Points Question What clinical measures collected acutely in combat are associated with 5-year outcome in patients with concussive blast injury? Findings In this longitudinal cohort study, nonmedically evacuated blast concussion patients had significant and sustained symptoms of neurobehavioral impairment, mental health and global disability, whereas cognitive changes were unremarkable compared with combat-deployed nonconcussed controls. Assessments collected in theater were associated with multiple domains of outcome. Meaning Nonmedically evacuated patients with concussive blast injury, considered the mildest of the mild combat casualties fared poorly 5 years later compared with combat-deployed controls.

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Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury

et al. 2017

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The long-term clinical effects of wartime traumatic brain injuries (TBIs), most of which are mild, remain incompletely described. Current medical disability cost estimates from world conflicts continually surpass projections. Additional information regarding long-term functional trajectory is needed to reduce this extensive public health burden.OBJECTIVES To examine 5-year clinical outcomes leveraging existing clinical data collected at 1 year after injury in the same patients and to identify early risk factors for long-term disability. DESIGN, SETTING, AND PARTICIPANTSThis prospective, longitudinal study enrolled active-duty US military after concussive blast injury (n = 50) in the acute to subacute stage and combat-deployed control individuals (n = 44) in Afghanistan or after medical evacuation to Germany from November 1, 2008, through July 1, 2013. One-and 5-year clinical evaluations were completed in the United States. All concussive blast injuries met the Department of Defense definition of mild, uncomplicated TBI. In-person clinical evaluations included standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden that were essentially identical to the evaluations completed at 1-year follow-up. Data were analyzed from October 1 through November 30, 2016. MAIN OUTCOMES AND MEASURESChanges in the in-person standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden from the 1-to 5-year follow-up. Predictive modeling was used to identify early risk factors for long-term disability. RESULTS Among the 94 participants (87 men [93%] and 7 women [7%]; mean [SD] age, 34[8] years), global disability, satisfaction with life, neurobehavioral symptom severity, psychiatric symptom severity, and sleep impairment were significantly worse in patients with concussive blast TBI compared with combat-deployed controls, whereas performance on cognitive measures was no different between groups at the 5-year evaluation. Logistic regression on the dichotomized Extended Glasgow Outcome Scale (GOS-E) at 5 years as a measure of overall disability identified brain injury diagnosis, preinjury intelligence, motor strength, verbal fluency, and neurobehavioral symptom severity at 1 year as risk factors for a poor outcome at 5 years, with an area under the curve of 0.92 indicating excellent prediction strength. Thirty-six of 50 patients with concussive blast TBI (72%) had a decline in the GOS-E from the 1-to 5-year evaluations, in contrast with only 5 of 44 combat-deployed controls (11%). Worsening of symptoms in concussive blast TBI was also observed on measures of posttraumatic stress disorder and depression. Service members with concussive blast TBI experienced evolution, not resolution, of symptoms from the 1-to 5-year outcomes.CONCLUSIONS AND RELEVANCE Considerable decline was observed in military service members with concussive blast TBI when comparing 1-and 5-year clinical outcomes. These results advocate for new treatment strategies to combat the long-te...

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Postconcussive Symptoms After Blast and Nonblast-Related Mild Traumatic Brain Injuries in Afghanistan and Iraq War Veterans

Cited by 110 publications

References 46 publications

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Association Between 5-Year Clinical Outcome in Patients With Nonmedically Evacuated Mild Blast Traumatic Brain Injury and Clinical Measures Collected Within 7 Days Postinjury in Combat

Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury

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