A case–control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI

Abstract

BackgroundMild traumatic brain injury (mTBI) is a common injury among military personnel serving in Iraq or Afghanistan. The impact of repeated episodes of combat mTBI is unknown.ObjectiveTo evaluate relationships among mTBI, post-traumatic stress disorder (PTSD) and neurological deficits (NDs) in US veterans who served in Iraq or Afghanistan.MethodsThis was a case–control study. From 2091 veterans screened for traumatic brain injury, the authors studied 126 who sustained mTBI with one or more episodes of loss of consciousness (LOC) in combat. Comparison groups: 21 combat veterans who had definite or possible episodes of mTBI without LOC and 21 veterans who sustained mTBI with LOC as civilians.ResultsAmong combat veterans with mTBI, 52% had NDs, 66% had PTSD and 50% had PTSD and an ND. Impaired olfaction was the most common ND, found in 65 veterans. The prevalence of an ND or PTSD correlated with the number of mTBI exposures with LOC. The prevalence of an ND or PTSD was >90% for more than five episodes of LOC. Severity of PTSD and impairment of olfaction increased with number of LOC episodes. The prevalence of an ND for the 34 combat veterans with one episode of LOC (4/34=11.8%) was similar to that of the 21 veterans of similar age and educational background who sustained civilian mTBI with one episode of LOC (2/21=9.5%, p-NS).ConclusionsImpaired olfaction was the most frequently recognised ND. Repeated episodes of combat mTBI were associated with increased likelihood of PTSD and an ND. Combat setting may not increase the likelihood of an ND. Two possible connections between mTBI and PTSD are (1) that circumstances leading to combat mTBI likely involve severe psychological trauma and (2) that altered cerebral functioning following mTBI may increase the likelihood that a traumatic event results in PTSD.

Healthcare utilization and costs of Veterans screened and assessed for traumatic brain injury

“…The proportion of Veterans who screened positive for TBI and also had PTSD was more than twice the proportion that screened negative for TBI and also had PTSD (32% vs 13%). Our findings are consistent with previous studies that have also found an association between mild TBI and PTSD with about 40 percent of individuals with combat-related mild TBI also having PTSD [2,[31][32]. Our study included some patients with more severe TBI, and it has been previously found that the risk of developing PTSD may be higher for a Veteran with combat-related mild TBI than severe TBI [33].…”

Identification of pseudobulbar affect symptoms in Veterans with possible traumatic brain injury

“…False positive screens for TBI may occur if the Veteran has other conditions, including PTSD or other conditions that have concussion-like symptoms, such as hearing loss and vestibular changes [21]. The proportion of screened TBI Veterans who completed a secondary TBI assessment and subsequently received a physician diagnosis of TBI was 53 percent, which is consistent with the proportion of approximately 60 percent found in other studies [22][23]. The reported symptom prevalence was similar in both the screened TBI and the confirmed TBI groups (70% vs 72%).…”

VA SmartHome for Veterans with TBI: Implementation in Community Settings

“…Approximately 1.7 million individuals sustain a TBI each year and over 3.2 million people are living with the long-term effects of this injury [4,5]. It has been suggested that these numbers maybe under-reported due to those with mild TBI not seeking medical attention [6]. In addition, these numbers do not account for brain injuries treated in military treatment facilities, during deployment and in Veterans Affairs hospitals.…”