Blast-related mild traumatic brain injury in the acute phase: Acute stress reactions partially mediate the relationship between loss of consciousness and symptoms

Norris, Jacob; Sams, Richard; Lundblad, Peter; Frantz, Earl; Harris, Erica

doi:10.3109/02699052.2014.891761

Cited by 29 publications

(29 citation statements)

References 57 publications

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“…Norris showed that TBI with loss of consciousness (LOC) was associated with greater self-reported difficulty sleeping compared to TBI without LOC in 210 active duty SMs who reported sustaining an mTBI to a US military-operated concussion clinic in Afghanistan. The greatest self-reported sleep difficulty associated with LOC was endorsed at 72 hours post-injury and again 48-72 hours after the initial TBI assessment (Norris, Sams, Lundblad, Frantz, & Harris, 2014). These findings suggest that the onset of sleep disturbance can occur immediately following the point of injury and are strongly associated with LOC.…”

Section: Time Course Of Sleep Disturbances and Tbimentioning

confidence: 71%

Traumatic brain injury and sleep disturbances in combat-exposed service members and veterans: Where to go next?

McKeon

Stocker

Germain

2019

NRE

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OBJECTIVE: To synthesize the current evidence on sleep disturbances in military service members (SMs) and veterans with traumatic brain injury (TBI). METHODS: An electronic literature search first identified abstracts published from 2008-2018 inclusively referencing sleep, TBI, and military personnel from Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn, and Persian Gulf veterans. Selection criteria eliminated studies on non-combat TBI, open or penetrating injuries, and articles where the relationship between sleep and TBI was not directly examined. Articles on all military branches and components, those currently serving and veterans-ranging from medical chart reviews to clinical trials, were included. Forty-one articles were selected for full text-review. RESULTS: Twenty-four papers estimated the prevalence of sleep disturbances in TBI. Eight studies demonstrated the contribution of common co-occurring conditions, most notably posttraumatic stress disorder, to the relationship between disrupted sleep and TBI. Ten studies differentiated sleep profiles between military SMs and veterans with and without acute TBI and detected significant differences in sleep disturbances across the course of injury. Longitudinal studies were scarce but helped to establish the temporal relationship between sleep disturbances and TBI and isolate sleep-related mechanisms influencing TBI prognosis. Only three studies reported on interventions for improving sleep quality and TBI symptoms. Systematic research testing assessments and interventions that target sleep disturbances for improving sleep, TBI symptoms, and long-term functional outcomes were identified as critical knowledge gaps. CONCLUSION: Findings unequivocally establish that sleep disturbances are highly prevalent in SMs and veterans with TBI. However, studies testing the effectiveness of treatments for improving sleep in military groups with TBI have been limited and their results inconsistent. This review highlights a critical opportunity for advancing military medicine through future research aimed at identifying and testing sleep-focused treatments in SMs and veterans with combat-related TBI.

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Section: Time Course Of Sleep Disturbances and Tbimentioning

confidence: 71%

Traumatic brain injury and sleep disturbances in combat-exposed service members and veterans: Where to go next?

McKeon

Stocker

Germain

2019

NRE

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“…Numerous studies have shown an association between blast-related (and non-blast-related) TBI and deficits in physiological and cognitive abilities (Norris et al, 2014;Scheibel et al, 2012). See Bogdanova and Verfaellie (2012) for review.…”

Section: Blast Exposurementioning

confidence: 99%

“…This question has been tested recently with mixed results. According to several studies, differences do not exist between blast and non-blast-related TBI on measures of postconcussion symptom endorsement and various neuropsychological and cognitive measures (Cooper et al, 2012;Luethcke et al, 2011;Neipert et al, 2014;Norris et al, 2014). Differences between blast and non-blast-related TBI have been demonstrated, however, on measures of white matter integrity (Taber et al, 2014) and neural activation during response inhibition (Fischer et al, 2014) using magnetic resonance imaging.…”

Section: Blast Exposurementioning

confidence: 99%

Discriminating military and civilian traumatic brain injuries

Reid

Vélez

2015

Molecular and Cellular Neuroscience

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“…Unfortunately, multiple decision criteria (New Orleans Criteria, Canadian CT Head Rule) identifying which patients are at risk of having an ICH after TBI have excluded patients without documented LOC (24,25). This exclusion criterion removes 30 to 50% of all TBI patients, a large proportion of which might be at risk of having a symptom-free ICH due to age-related cerebral atrophy (4)(5)(6)(7)(8)(9). There is a need for more research investigating if the risk of an in-hospital delayed ICH is modified by the presence or absence of documented LOC following a mTBI.…”

Section: Discussionmentioning

confidence: 99%

“…Across nearly 2,500 patients with a Glasgow coma scale (GCS) of 15, the risk of documented LOC was 69% (4). Similarly, in a population of 210 blastrelated TBIs, the risk of documented LOC was 68% (5). In other studies examining mild to moderate TBI, however, the risk of documented LOC was lower (40-55%) (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

In Patients Over 50 Years, Increased Age Is Associated With Decreased Odds of Documented Loss of Consciousness After a Concussion

et al. 2020

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Background: Advanced aged adults have the highest rate of traumatic brain injury (TBI) related hospital admissions, compared to younger age groups. Data were published in 2014 indicating differential injury and neurological responses to a TBI by age categories. In a recent article examining patients with mTBI and isolated subdural hematoma, it was found that older patients had a decreased risk of documented loss of consciousness (LOC). The primary objective was to determine the extent to which the odds of documented LOC changes with increasing age in a population of older adults suffering an isolated concussion and uncomplicated mTBI.Methods: This was a retrospective study utilizing 6 years (2010-2015) of National Trauma Data Bank data. This study included patients with (1) diagnosis of concussion; (2) positive or negative loss of consciousness; (3) loss of consciousness durations no longer than 59 min or undefined; (4) age ≥50 years; (5) had a "fall" mechanism of injury; and (6) a valid emergency department Glasgow coma scale 13-15. We excluded patients (1) with any intracranial hemorrhage or intracranial injury of other and unspecified nature; (2) skull fracture; (3) an injury severity scale score >17; (4) a concussion with "unspecified" LOC (ICD-9: 850.9).Results: There were 7,466 patients included in the study; the median (IQR) age was 70 (60-80) years. The risk of documented LOC was 71% (n = 5,319). An 80-year-old had 72% decreased odds of having a documented LOC, compared to a 50-year-old (OR = 0.28, 99.5%CI [0.23-0.34], P < 0.001). This association held when controlling for multiple demographic, comorbid, and clinical variables, and in sensitivity analyses. Conclusion:These nationwide data suggest that in patients aged ≥50 years, a significant inverse association exists between age and odds of documented LOC after Orlando et al.Age vs. Loss of Consciousness sustaining a fall-related concussion. Additional studies are needed to validate these findings and to investigate the triad of age, documented LOC, and intracranial hemorrhage. Clinical diagnostic criteria relying on LOC might be at risk of being modified by the association between increasing age and decreasing odds of LOC.

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Blast-related mild traumatic brain injury in the acute phase: Acute stress reactions partially mediate the relationship between loss of consciousness and symptoms

Abstract: Results suggest ASR may partially mediate symptom presentation and cognitive dysfunction in the acute phase following blast-related mTBI. Future research is warranted.

Cited by 29 publications

References 57 publications

Traumatic brain injury and sleep disturbances in combat-exposed service members and veterans: Where to go next?

Traumatic brain injury and sleep disturbances in combat-exposed service members and veterans: Where to go next?

Discriminating military and civilian traumatic brain injuries

In Patients Over 50 Years, Increased Age Is Associated With Decreased Odds of Documented Loss of Consciousness After a Concussion

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