Military Occupations Most Affected by Head/Sensory Injuries and the Potential Job Impact of Those Injuries

Lawson, Ben D.; Kass, Steven J.; Dhillon, Kieran K.; Milam, Lana; Cho, Timothy H; Rupert, Angus H.

doi:10.7205/milmed-d-15-00184

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…The detection of a difference in tinnitus shown in these results suggests that this method for discovery was effective. In addition, this finding was consistent with a previous epidemiological study that showed association between combat arms MOSs (infantry) and risk for auditory injury (17), although that study approach used injury codes to search for MOS association rather than the approach presented here, using MOS categories to evaluate differences in injury rates. To further assess the potential for risk from occupational exposure to blast, following studies could explore annual hearing assessment results in conjunction with MOS as an additional proxy for longitudinal exposure to blast.…”

Section: Discussionsupporting

confidence: 90%

“…Professional communities exposed to blast in their occupational roles may have exposures during tactical operations, but they will all have exposures during routine training, for acquiring needed skills as well as maintaining those skills over time. Occupation-based estimates of risk from exposure history have been revealed for military occupational specialties (MOSs) in previous studies ( 17 – 19 ) and could serve to prevent injury as has been recommended for contact sports ( 20 ).…”

Section: Introductionmentioning

confidence: 99%

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Association of MOS-Based Blast Exposure With Medical Outcomes

et al. 2020

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The study of effects associated with human exposure to repeated low-level blast during training or operations of select military occupational specialties (MOS) challenges medical science because acute negative effects that might follow such exposures cannot be expected to be clear or prevalent. Any gross effects from such occupational blast exposure on health or performance should be expected to have been already identified and addressed by affected military units through changes to their standard training protocols. Instead, effects, if any, should be expected to be incremental in nature and to vary among individuals of different susceptibilities and exposure histories. Despite the challenge, occupational blast-associated effects in humans are emerging in ongoing research. The purpose of the present study was to examine medical records for evidence of blast-associated effects that may have clinical significance in current standard of care. We hypothesized that populations exposed to blast by virtue of their military occupation would have poorer global medical outcomes than cohorts less likely to have been occupationally exposed. Records from a population of 50,254 service members in MOSs with a high likelihood of occupational blast exposure were compared to records from a matched cohort of 50,254 service members in MOSs with a lower likelihood of occupational blast exposure. These two groups were compared in hospitalizations, outpatient visits, pharmacy, and disability ratings. The clearest finding was higher risk among blast-exposed MOSs for ambulatory encounters for tinnitus, with adjusted risk ratios of 1.19 (CI 1.03-1.37), 1.21 (CI 1.16-1.26), and 1.31 (CI 1.18-1.45) across career time points. Other hypothesized effects (i.e., neurological outcomes) were smaller and were associated with acute exposure. This study documents that service members in occupations that likely include repeated exposure to blast are at some increased risk for neurosensory conditions that present in medical evaluations. Other hypothesized risks from occupational exposure may manifest as symptomology not visible in the medical system or current standard of care. Separate studies, observational and epidemiological, are underway to evaluate further the potential for occupational risk, but the evidence presented here may indicate near-term opportunities to guide efforts to reduce neurosensory risk among exposed service members.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Association of MOS-Based Blast Exposure With Medical Outcomes

et al. 2020

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“…Sensory impairments affect military service members readiness for deployment (169), job performance (170), and quality of life (171). The blast-related mTBI participants in these studies had a 100% report rate for some level of hearing disturbance immediately following the blast and symptoms persisted upwards of 6 months post-deployment (87,88,114,117,138).…”

Section: Discussionmentioning

confidence: 97%

Characteristics and Impact of U.S. Military Blast-Related Mild Traumatic Brain Injury: A Systematic Review

et al. 2020

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As a result of armed conflict, head trauma from exposure to blasts is an increasing critical health issue, particularly among military service members. Whilst numerous studies examined the burden of blast-related brain injuries on service members', few systematic reviews have been published. This work provides a comprehensive summary of the evidence on blast-related mild traumatic brain injury (mTBI) burden in active U.S. military service members and inactive Veterans, describing characteristics and outcomes. Records published up to April 2017 were identified through a search of PubMed, Web of Science, Scopus, Ovid MEDLINE, and Cochrane Library. Records-based and original research reporting on U.S. military service members and Veterans with mild blast TBI were included. Data on subject characteristics, exposure, diagnostic criterion, and outcomes were extracted from included studies using a standardized extraction form and were presented narratively. Of the 2,290 references identified by the search, 106 studies with a total of 37,515 participants met inclusion criteria for blast-related mTBI. All but nine studies were based out of military or Veteran medical facilities. Unsurprisingly, men were over-represented (75-100%). The criteria used to define blast-related mTBI were consistent; however, the methodology used to ascertain whether individuals met those criteria for diagnosis were inconsistent. The diagnosis, most prevalent among the Army, heavily relied on self-reported histories. Commonly reported adverse outcomes included hearing disturbances and headaches. The most frequently associated comorbidities were post-traumatic stress disorder, depression, anxiety, sleep disorders, attention disorders, and cognitive disorders. The primary objective of this review was to provide a summary of descriptive data on blast-related mTBI in a U.S. military population. Low standardization of the methods for reaching diagnosis and problems in the study reporting emphasize the importance to collect high-quality data to fill knowledge gaps pertaining to blast-related mTBI.

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“…Survivors might experience similar benefit and outcomes from rehabilitation compared with survivors of nonpenetrating injuries, 13 but more data about risk factors and trajectories of recovery are needed, especially to determine whether specialized prevention and intervention approaches may be warranted. Available literature on penetrating TBIs, and particularly FI-related TBI, however, consists of small sample sizes or case studies, [14][15][16] targets specific populations (eg, military service members), 17 and/or focuses only on descriptive sociodemographic data. 12,13,18,19 More data about injury and clinical characteristics and outcomes among civilian FIrelated TBI survivors are needed to develop appropriate prevention and rehabilitation programs for these individuals, particularly given the unique issues surrounding such injuries.…”

mentioning

confidence: 99%