Repeated concussion among U.S. military personnel during Operation Iraqi Freedom

Abstract

Abstract-Concussions are a predominant injury of the conflicts in Iraq and Afghanistan. The aims of this study were to describe repeated concussive events among U.S. military personnel injured in Operation Iraqi Freedom and examine subsequent healthcare utilization. We reviewed clinical records from the Expeditionary Medical Encounter Database to identify servicemembers with repeat concussions. We abstracted demographic and injury-specific variables, calculated time between events, and identified healthcare utilization from electronic medical databases. Overall, 113 personnel experienced more than one concussion between 2004 and 2008. A majority of these incidents were blast related. The median time between events was 40 days, with 20% experiencing a second event within 2 weeks of the first and 87% within 3 months. Time between events was not associated with severity of the second event. Greater severity of the second concussive event was associated with higher postinjury utilization of mental health and neurology services. This study is one of the first to describe repeated concussions in a combat setting. We found that repeated concussions occur within a short interval among deployed personnel, although the effects of the first event are unclear. Further research is needed to define the effect of repeated concussions on the health of combat veterans.

Development of a comprehensive Blast-Related Auditory Injury Database (BRAID)

“…Given the noise hazards prevalent in combat settings, it is critical that deployers obtain a monitoring audiogram before and after deployment. Our findings on causality and types of battle injuries are consistent with other studies [7,[40][41][42]. In general, the most common audiologic symptoms reported in victims of blast are tinnitus and hearing loss, with a significant proportion of patients reporting concomitant tinnitus and hearing loss.…”

A Multisite Study of the Relationships between Blast Exposures and Symptom Reporting in a Post-Deployment Active Duty Military Population with Mild Traumatic Brain Injury

“…8 A study of deployed U.S. service members found that 87% of second concussions occurred within 30 days of the initial injury, and that severity of the second injury (but not the first) was associated with higher use of mental health and neurological services during the 2 years after injury. 9 This is of concern because early evidence suggests that close temporal proximity of multiple head injuries is associated with poorer recovery. Another study found that Florida National Guard personnel were more likely to receive a diagnosis of probable major depression, anxiety, post-traumatic stress disorder (PTSD), and postconcussion syndrome if they reported sustaining multiple MTBIs, as opposed to a single injury.…”

Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot

“…According to the Department of Veterans Affairs (VA) and the Department of Defense, the criteria for an mTBI are-A physiological disruption of brain function as a result of a traumatic event as manifested by at least one of the following: alteration of mental state, loss of consciousness (LOC), loss of memory or focal neurological deficit, that may or may not be transient; but where the severity of the injury does not exceed the following: post-traumatic amnesia (PTA) for greater than 24 hours, after the first 30 minutes Glasgow Coma Score (GCS) [13][14][15], and loss of consciousness is less than 30 minutes. [5] While penetrating TBI events are apparent immediately, mTBIs often go unrecognized [6].…”

“…The accurate proportion of mTBI among injured servicemembers is in all probability higher than reported because closed TBIs are not diagnosed in a prompt manner [7]. The incidence of TBI among Iraq and Afghanistan Veterans is approximately 15 to 20 percent, with research demonstrating that mTBI is the most common form of TBI among this Veteran cohort [2,[8][9][10][11][12][13][14]. Because of multiple deployments and exposures to blasts, some of these Veterans have sustained repeated mTBIs [13].…”

“…The incidence of TBI among Iraq and Afghanistan Veterans is approximately 15 to 20 percent, with research demonstrating that mTBI is the most common form of TBI among this Veteran cohort [2,[8][9][10][11][12][13][14]. Because of multiple deployments and exposures to blasts, some of these Veterans have sustained repeated mTBIs [13]. The cognitive difficulties resulting from TBI include attention deficits, lack of concentration, impaired learning, executive control dysfunctions, and memory loss [3][4][5][15][16][17].…”