Influence of Combat Blast-Related Mild Traumatic Brain Injury Acute Symptoms on Mental Health and Service Discharge Outcomes

Abstract

Assessment of acute mild traumatic brain injury (mTBI) symptoms after a combat blast could aid diagnosis and guide follow-up care. Our objective was to document acute mTBI symptoms following a combat blast and to examine associations between acute symptoms and mental health and service discharge outcomes. A retrospective cohort study was conducted with 1656 service personnel who experienced a combat blast-related mTBI in Iraq. Acute mTBI symptoms were ascertained from point-of-injury medical records. The associations between acute symptoms and posttraumatic stress disorder (PTSD), postconcussion syndrome (PCS), and type of service discharge were examined. Disability discharge occurred in 11% of patients, while 36% had a non-disability discharge and 52% had no recorded discharge. A PTSD and PCS diagnosis was made in 19% and 15% of the sample, respectively. The most common acute mTBI symptoms were headache (62.8%), loss of consciousness (LOC) (34.5%), and tinnitus (33.2%). LOC was predictive of PTSD (odds ratio [OR] 1.54; 95% confidence interval [CI] 1.18, 2.00) and PCS (OR 2.08; 95% CI 1.56, 2.77), while altered mental status (OR 1.53; 95% CI 1.07, 2.17) and previous blast history (OR 1.83; 95% CI 1.15, 2.90) also were predictive of PCS. While no acute mTBI symptoms were associated with discharge outcomes, injury severity was associated with disability discharge. LOC after blast-related mTBI was associated with PTSD and PCS, and injury severity was predictive of disability discharge. The assessment of cognitive status immediately after a blast could assist in diagnosing mTBI and indicate a need for follow-up care.

Chronic effects of exposure to high-intensity blasts: Results on tests of central auditory processing

“…While PTSD and TBI are often present in the same individuals, this correlation by itself does not imply that PTSD is primarily responsible for central auditory processing deficits. One alternative hypothesis that could explain some of the relationships observed here and in other studies between TBI and PTSD is that blast exposure can damage the brain in many ways, one of which may be to make an individual more likely to be diagnosed with PTSD [21][22]. It would be beneficial if future studies are designed in a way that enables researchers to reveal the full set of relationships among TBI, PTSD, central auditory processing, sensory processing in general, and cognitive processes such as memory, attention, and executive function.…”

Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury

“…2,3,8 Following brain injury, a lack of social support, increased life stress, poor health satisfaction ratings, and presence of disability are associated with risk of PTSD. 2,7,8,[15][16][17] However, the relative contributions of each risk factor and consensus as to the most salient factors for the development of PTSD symptoms in a civilian population following TBI has yet to be established.…”

“…In military populations, self-reported concussive and PTSD symptoms after TBI was associated with disability at time of military discharge. 16 Similarly, soldiers evacuated following a blast injury resulting in TBI had greater disability, as measured by the Glasgow Outcome ScaleExtended (GOS-E), than those evacuated for other medical reasons. 17 There have been multiple reports of associations between lower GOS-E, depression, post-concussive symptoms, and PTSD in civilian 16 and military populations.…”

“…16 Similarly, soldiers evacuated following a blast injury resulting in TBI had greater disability, as measured by the Glasgow Outcome ScaleExtended (GOS-E), than those evacuated for other medical reasons. 17 There have been multiple reports of associations between lower GOS-E, depression, post-concussive symptoms, and PTSD in civilian 16 and military populations. 17,18 Specifically, up to 87% of service members with TBI meeting PTSD symptom screening criteria demonstrate concurrent moderate disability on the GOS-E (£ 6).…”

Alterations in autobiographical memory for a blast event in Operation Enduring Freedom and Operation Iraqi Freedom veterans with mild traumatic brain injury.

“…MTBI is associated with at least transient disruption of brain functioning at the time of the event, manifested by alteration or loss of consciousness (LOC) up to 30 minutes and loss of memory for events immediately before or after the injury, with posttraumatic amnesia (PTA; i.e., a persistent difficulty in remembering events occurring immediately after the injury) no longer than 24 hours (Ruff, 2005). During the acute phase of injury, cognitive impairment is commonly observed in mTBI (Eskridge et al, 2013;McCrea, 2001;McCrea, Kelly, Randolph, Cisler, & Berger, 2002), which includes reduced memory for the injury event itself (Eskridge et al, 2013). Although most cognitive deficits do not endure in the majority of people who have suffered an mTBI, (e.g., McCrea, 2001;McCrea et al, 2002; but see e.g., Pertab, James, & Bigler, 2009;Pontifex, O'Connor, Broglio, & Hillman, 2009), it is unknown whether difficulties in memory for the injury event persist.…”