Self-Reported Mild TBI and Postconcussive Symptoms in a Peacetime Active Duty Military Population

Miller, Kelly J.; Ivins, Brian; Schwab, Karen

doi:10.1097/htr.0b013e318255ceae

Cited by 40 publications

(34 citation statements)

References 35 publications

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“…Postconcussive syndrome may be present in cases in which these symptoms associated with breaching and other repeated low-level blast exposure are prolonged. 12,16,19,27,[31][32][33] Clinical diagnoses were outside the scope of this survey, but given the observation of symptoms interfering with daily activity, blast surveillance may be warranted in those professional communities exposed to occupational blast. 34 There are a number of limitations to this survey that should be noted.…”

Section: Discussionmentioning

confidence: 99%

“…Such singleitem descriptors, however, have been reported in similar research. 12 Finally, the survey did not elicit deployment histories or address specifically whether a subject has experienced any traumatic events. These limitations could be mitigated by the inclusion of the comparison group, subject to the same considerations.…”

Section: Discussionmentioning

confidence: 99%

“…10 Furthermore, the repeated nature of these exposures among personnel in these professions, both operational and training exposures, could be expected to have cumulative effects as are indicated for repeated concussion. 11,12 Such effects from explosive breaching would be more attributable as primary blast effects and less attributable to concomitant risk factors. Thus, the breacher community represents a population for study of effects on humans from multiple exposures to lowlevel explosive blast.…”

mentioning

confidence: 99%

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Relation of Repeated Low-Level Blast Exposure With Symptomology Similar to Concussion

Carr¹,

Polejaeva

Grome

et al. 2015

Journal of Head Trauma Rehabilitation

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Relation of Repeated Low-Level Blast Exposure With Symptomology Similar to Concussion

Carr¹,

Polejaeva

Grome

et al. 2015

Journal of Head Trauma Rehabilitation

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“…The risk for persistent post-concussive symptoms and neurocognitive impairment following multiple concussions may depend on when they occurred-how close together and how recent. 20,42 Second, information about prior concussions was collected by retrospective self-report. Confirmation of concussion diagnosis and objective measures of injury severity were not available.…”

Section: Limitationsmentioning

confidence: 99%

Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers

Dretsch

Silverberg

Iverson

2015

Journal of Neurotrauma

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The extent to which multiple past concussions are associated with lingering symptoms or mental health problems in military service members is not well understood. The purpose of this study was to examine the association between lifetime concussion history, cognitive functioning, general health, and psychological health in a large sample of fit-for-duty U.S. Army soldiers preparing for deployment. Data on 458 active-duty soldiers were collected and analyzed. A computerized cognitive screening battery (CNS-Vital Signs(®)) was used to assess complex attention (CA), reaction time (RT), processing speed (PS), cognitive flexibility (CF), and memory. Health questionnaires included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-M), Zung Depression and Anxiety Scales (ZDS; ZAS), Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Alcohol Use and Dependency Identification Test (AUDIT). Soldiers with a history of multiple concussions (i.e., three or more concussions) had significantly greater post-concussive symptom scores compared with those with zero (d=1.83, large effect), one (d=0.64, medium effect), and two (d=0.64, medium effect) prior concussions. Although the group with three or more concussions also reported more traumatic stress symptoms, the results revealed that traumatic stress was a mediator between concussions and post-concussive symptom severity. There were no significant differences on neurocognitive testing between the number of concussions. These results add to the accumulating evidence suggesting that most individuals recover from one or two prior concussions, but there is a greater risk for ongoing symptoms if one exceeds this number of injuries.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Reid

Miller

Lange

et al. 2014

Journal of Neurotrauma

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Explosive devices have been the most frequent cause of traumatic brain injury (TBI) among deployed contemporary U.S. service members. The purpose of this study was to examine the influence of previous cumulative blast exposures (that did or did not result in TBI) on later post-concussion and post-traumatic symptom reporting after sustaining a mild TBI (MTBI). Participants were 573 service members who sustained MTBI divided into four groups by number of blast exposures (1, 2, 3, and 4-10) and a nonblast control group. Post-concussion symptoms were measured using the Neurobehavioral Symptom Inventory (NSI) and post-traumatic stress disorder (PTSD) symptoms using the Post-traumatic Checklist-Civilian version (PCL-C). Results show groups significantly differed on total NSI scores ( p < 0.001), where symptom endorsement increased as number of reported blast exposures increased. Total NSI scores were significantly higher for the 3-and 4-10 blast groups compared with the 1-and 2-blast groups with effect sizes ranging from small to moderate (d = 0.31 to 0.63). After controlling for PTSD symptoms using the PCL-C total score, NSI total score differences remained between the 4-10-blast group and the 1-and 2-blast groups, but were less pronounced (d = 0.35 and d = 0.24, respectively). Analyses of NSI subscale scores using PCL-C scores as a covariate revealed significant between-blast group differences on cognitive, sensory, and somatic, but not affective symptoms. Regression analyses revealed that cumulative blast exposures accounted for a small but significant amount of the variance in total NSI scores (4.8%; p = 0.009) and total PCL-C scores (2.3%; p < 0.001). Among service members exposed to blast, post-concussion symptom reporting increased as a function of cumulative blast exposures. Future research will need to determine the relationship between cumulative blast exposures, symptom reporting, and neuropathological changes.

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Self-Reported Mild TBI and Postconcussive Symptoms in a Peacetime Active Duty Military Population

Abstract: Past experience of MTBI may be a risk factor for increased symptom difficulty for several months postinjury. Clinicians should ascertain lifetime history of brain injury when evaluating patients for MTBI.

Cited by 40 publications

References 35 publications

Relation of Repeated Low-Level Blast Exposure With Symptomology Similar to Concussion

Relation of Repeated Low-Level Blast Exposure With Symptomology Similar to Concussion

Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers

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

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