Sequelae of Blast Events in Iraq and Afghanistan War Veterans using the Salisbury Blast Interview: A CENC Study

Rowland, Jared A.; Martindale, Sarah L.; Spengler, Kayla; Shura, Robert D.; Taber, Katherine H.

doi:10.1080/02699052.2020.1729418

Cited by 22 publications

(18 citation statements)

References 28 publications

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“…An a priori chart abstraction process was designed by a multidisciplinary working group of NJ WRIISC clinicians and scientists with expertise in pulmonary medicine, internal medicine, environmental and occupational medicine, neuropsychology, and exercise physiology. Although several instruments are available to evaluate neuropsychological sequelae of TBI (blast-related and non-blast-related) (e.g., [ 8 , 9 ]), the working group was unable to identify an existing instrument designed to assess the impact of blast exposure on the cardiopulmonary system. Therefore, we developed a process and tool for extracting key variables from the clinical notes to derive an assessment of blast exposure.…”

Section: Methodsmentioning

confidence: 99%

“…Investigators observed an unadjusted association between their blast exposure severity score and lung clearance index (marker of ventilation heterogeneity) in 71 deployed individuals that was interpreted as evidence for a link between blast exposure and small airways injury. Whereas scoring instruments and standardized interviews exist to assess blast-related TBI and associated neuro-psychological sequelae beyond self-report [ 8 , 9 ], the validity of these approaches have not been assessed in the context of adverse respiratory system effects.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between clinician documented blast exposure and pulmonary function: a retrospective chart review from a national specialty clinic

Therkorn

Sotolongo

et al. 2022

Respir Res

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Background Service member exposure to explosive blast overpressure waves is common with considerable attention to traumatic brain injury (TBI) and neuropsychological sequalae. Less is known about the impacts on the respiratory system, particularly long-term effects, despite vulnerability to overpressure. Using a national registry, we previously observed an independent relationship between self-reported blast exposure and respiratory symptoms; however, the impact on objective measures of pulmonary function is poorly understood. Methods 307 Veterans referred to our national specialty center for post-deployment health concerns underwent a comprehensive multi-day evaluation that included complete pulmonary function testing (PFT), occupational and environmental medicine history, neuropsychological or psychological evaluation. We developed an a priori chart abstraction process and template to classify Veterans into blast exposure groups: (1) none, (2) single-mild, or (3) multiple-mild. This template focused primarily on clinician documented notes of blast related TBI that were used as proxy for blast overpressure injury to thorax. PFT variables characterizing flow (FEV1%; %∆FEV1), volume (TLC%), diffusion (DLCO%) and respiratory mechanics (forced oscillometry) were selected for analysis. Results Veterans (40.5 ± 9.7 years; 16.3% female) were referred 8.6 ± 3.6 years after their last deployment and presented with considerable comorbid conditions and health problems (e.g., 62% post-traumatic stress, 55% dyspnea). After chart abstraction, Veterans were assigned to none (n = 208), single mild (n = 52) and multiple mild (n = 47) blast exposure groups. Among the blast exposed, clinicians documented 73.7% were < 50 m from the blast and 40.4% were physically moved by blast. PFT outcome measures were similar across all groups (p value range: 0.10–0.99). Conclusions In this referred sample of deployed Veterans, PFT measures of flow, volume, diffusion, and respiratory mechanics were not associated with clinician documented blast exposure per the retrospective chart abstraction methodology applied. Yet, these clinical findings suggest future research should determine and assess distinction between Veteran recollections of perceived blast experiences versus overpressure wave exposure to the respiratory system.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationship between clinician documented blast exposure and pulmonary function: a retrospective chart review from a national specialty clinic

Therkorn

Sotolongo

et al. 2022

Respir Res

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“…severity), was measured using a behaviorally-anchored Likert scale ranging from 0 to 5 (0 = no pressure ; 5 = strong pressure , resulted in greater than minor injury). Notably, though higher reported blast pressure is more likely to result in a TBI (Rowland, Martindale, Spengler, et al, 2020), this is not a guaranteed outcome. Therefore, blast pressure severity and TBI represent independent but potentially related constructs.…”

Section: Methodsmentioning

confidence: 99%

“…The Salisbury Blast Interview (SBI; Rowland, Martindale, Spengler, et al, 2020) evaluated blast exposure history. The SBI gathers details about events involving blasts/explosions across the life span, regardless of distance or severity.…”

Section: Clinical Interviewsmentioning

confidence: 99%

Factors associated with recovery from posttraumatic stress disorder in combat veterans: The role of deployment mild traumatic brain injury (mTBI).

Ord¹,

Epstein²,

Shull³

et al. 2022

Rehabilitation Psychology

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Objective: Examine factors associated with recovery from posttraumatic stress disorder (PTSD) and evaluate the role of deployment mild traumatic brain injury (mTBI) in the relationship between PTSD recovery and functional outcomes. Method: Post 9/11 combat veterans with lifetime history of PTSD (N = 124, 84.7% male) completed the Mid-Atlantic MIRECC Assessment of Traumatic Brain Injury (MMA-TBI), Salisbury Blast Interview (SBI), Clinician Administered PTSD scale (CAPS-5), cognitive assessment battery, and measures of depression, PTSD symptoms, neurobehavioral symptoms, sleep quality, pain interference, and quality of life. Results: Analyses of variance (ANOVA) results revealed significant differences in most behavioral health outcomes based on PTSD recovery, with participants who have recovered from PTSD showing less severe neurobehavioral and depressive symptoms, better sleep quality, less functional pain interference, and higher quality of life. No differences were found in cognitive functioning between those who have recovered from PTSD and those who have not. History of deployment mTBI did not significantly moderate the relationship between PTSD recovery and most functional and cognitive outcomes with the exception of 2 measures of processing speed. Specifically, among participants with history of deployment mTBI, those who have recovered from PTSD displayed better cognitive functioning than those who have not. Additionally, participants who have not recovered from PTSD had higher levels of blast exposure during military service. Conclusions: PTSD recovery was associated with better psychological functioning and higher quality of life, but not with objective cognitive functioning. Deployment mTBI history moderated only the relationship between PTSD recovery status and tests of processing speed.

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“…The SBI, designed at the W. G. (Bill) Hefner VA Healthcare System, is unique from the other developed measures as it is a structured interview rather than a self-report questionnaire. It is intended to be completed in 10–30 min and provides a characterization of blast exposure across the lifespan ( 7 ). The interview queries any and all exposures to blast sustained in military service, to include those exposures that occurred during combat.…”

Section: Self-report Measures Of Career Blastmentioning

confidence: 99%

Perspectives on Development of Measures to Estimate Career Blast Exposure History in Service Members and Veterans

et al. 2022

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The Department of Defense (DOD) has recently prioritized the investigation of the acute and chronic adverse brain health and performance effects of low-level blast (LLB) generated by the use of weapons systems. While acute exposure can be quantified by sensor technology, career exposure has no widely accepted and validated measure for characterization. Currently, distinct research groups are developing and validating four promising measures to estimate career blast exposure history: the Salisbury Blast Interview, Blast Exposure Threshold Survey, Blast Ordnance and Occupational Exposure Measure, and the Blast Frequency and Symptom Severity. Each measure offers an assessment of blast history that is uniquely beneficial to addressing specific research questions. However, use of divergent strategies is not efficient to accelerate the field's understanding of the impact of career exposure and Service-connected health outcomes. As a DOD-wide solution, collaboration across these groups is required to develop a tool(s) that can be standardized across research studies and, ultimately, pared down to be implemented in clinical settings. Here, we overview the current four measures and provide a perspective on the way forward for optimization and/or combination in support of this solution.

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Sequelae of Blast Events in Iraq and Afghanistan War Veterans using the Salisbury Blast Interview: A CENC Study

Cited by 22 publications

References 28 publications

Relationship between clinician documented blast exposure and pulmonary function: a retrospective chart review from a national specialty clinic

Relationship between clinician documented blast exposure and pulmonary function: a retrospective chart review from a national specialty clinic

Factors associated with recovery from posttraumatic stress disorder in combat veterans: The role of deployment mild traumatic brain injury (mTBI).

Perspectives on Development of Measures to Estimate Career Blast Exposure History in Service Members and Veterans

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