Understanding Treatment of Mild Traumatic Brain Injury in the Military Health System

Farmer, Carrie M.; Krull, Heather; Concannon, Thomas W.; Simmons, Molly M.; Pillemer, Francesca; Ruder, Teague; Parker, Andrew M.; Purohit, Maulik P.; Hiatt, Liisa; Batorsky, Benjamin Saul; Hepner, Kimberly A.

doi:10.7249/rr844

Cited by 19 publications

(26 citation statements)

References 61 publications

(108 reference statements)

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“…Our findings demonstrated that occupational risk for LLB may be associated with greater susceptibility to concussion and moderate TBIs, but not severe or penetrating TBIs, which are likely caused by sufficiently forceful events or impacts to the head to result in TBI regardless of occupational exposure to LLB. Interestingly, the effect of occupational risk for LLB exerted a stronger effect on moderate TBIs compared with concussions, which may be partially explained by the fact that people often do not seek medical care for a concussion, thus such effects would not be observed in studies using healthcare reimbursement records [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…It was possible for each service member to have been diagnosed with more than one type of TBI during the study period. Furthermore, given the direct focus on concussion in the present research, additional relevant conditions were recorded using case criteria established in a recent RAND report on concussion [ 32 ]. Diagnoses commonly comorbid with concussion that were identified for analysis included alteration in mental status, cognitive problems, communication disorders, dizziness/vertigo, gait and coordination problems, headache, hearing problems, non-headache pain, skin sensation disturbances, sleep disorders/symptoms, smell and taste disturbances, syncope/collapse, and vision problems.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Occupational Risk of Low-Level Blast Exposure and TBI-Related Medical Diagnoses: A Population-Based Epidemiological Investigation (2005–2015)

Belding

Englert

Bonkowski

et al. 2021

IJERPH

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Because traumatic brain injury (TBI)—most often caused by exposure to high-level blast (HLB)—is a leading cause of medical evacuations of deployed U.S. service members in recent conflicts, researchers seek to identify risk factors for TBI. Previous research using self-reported data has identified low-level blast (LLB) as one such risk factor and suggests an association with susceptibility to and symptoms associated with TBI. This article presents a population-based study of all branches of military service that examines the association between occupational risk for LLB and both clinically diagnosed TBIs—from concussions to severe and penetrating TBIs—and conditions commonly comorbid with concussion. Using archival medical and career records from >2 million service members between 2005–2015, this work demonstrates that occupational risk of LLB is associated with any TBI, mild TBI, moderate TBI, cognitive problems, communication problems, hearing problems, headaches, any behavioral health condition, anxiety, drug abuse/dependence, alcohol abuse/dependence, delirium/dementia, posttraumatic stress disorder, post-concussive syndrome, tinnitus, fatigue, and migraines. Understanding the full scope of the effects of LLB on service members will help ensure the health and readiness of service members and may influence both military policy and clinical practice guidelines for blast-induced injuries.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Occupational Risk of Low-Level Blast Exposure and TBI-Related Medical Diagnoses: A Population-Based Epidemiological Investigation (2005–2015)

Belding

Englert

Bonkowski

et al. 2021

IJERPH

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“…Military personnel are particularly at risk for TBI. Lack of access to safe and accessible transportation for deployed military personnel can delay treatment up to 72 h after TBI (Farmer et al, 2017). Thus, treatment gap likely contributes to negative outcomes after TBI.…”

Section: Therapeutic Time Window Is a Key Element Of Drugs To Treat Tbimentioning

confidence: 99%

The Importance of Therapeutic Time Window in the Treatment of Traumatic Brain Injury

2019

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Traumatic brain injury (TBI) is a major cause of death and disability. Despite its importance in public health, there are presently no drugs to treat TBI. Many reasons underlie why drugs have failed clinical trials, one reason is that most drugs to treat TBI lose much of their efficacy before patients are first treated. This review discusses the importance of therapeutic time window; the time interval between TBI onset and the initiation of treatment. Therapeutic time window is complex, as brain injury is both acute and chronic, resulting in multiple drug targets that appear and disappear with differing kinetics. The speed and increasing complexity of TBI pathophysiology is a major reason why drugs lose efficacy as time to first dose increases. Recent Phase III clinical trials treated moderate to severe TBI patients within 4–8 h after injury, yet they turned away many potential patients who could not be treated within these time windows. Additionally, most head trauma is mild TBI. Unlike moderate to severe TBI, patients with mild TBI often delay treatment until their symptoms do not abate. Thus, drugs to treat moderate to severe TBI likely will need to retain high efficacy for up to 12 h after injury; drugs for mild TBI, however, will likely need even longer windows. Early pathological events following TBI progress with similar kinetics in humans and animal TBI models suggesting that preclinical testing of time windows assists the design of clinical trials. We reviewed preclinical studies of drugs first dosed later than 4 h after injury. This review showed that therapeutic time window can differ depending upon the animal TBI model and the outcome measure. We identify the few drugs (methamphetamine, melanocortin, minocycline plus N-acetylcysteine, and cycloserine) that demonstrated good therapeutic windows with multiple outcome measures. On the basis of their therapeutic window, these drugs appear to be excellent candidates for clinical trials. In addition to further testing of these drugs, we recommend that the assessment of therapeutic time window with multiple outcome measures becomes a standard component of preclinical drug testing.

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“…In these cases, generally no emergency intervention is required. Mild TBI will be the focus of this review, as mTBIs account for 84% of military brain injuries [12] and have more recently been recognized as an important clinical entity. It should be noted that the definitions described below are not universally utilized, and differences in the definition of TBI severity across studies likely contribute to differences in conclusions.…”

Section: Considerations For the Study Of Military Tbimentioning

confidence: 99%

Neuroimaging of deployment-associated traumatic brain injury (TBI) with a focus on mild TBI (mTBI) since 2009

et al. 2017

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Understanding Treatment of Mild Traumatic Brain Injury in the Military Health System

Cited by 19 publications

References 61 publications

Occupational Risk of Low-Level Blast Exposure and TBI-Related Medical Diagnoses: A Population-Based Epidemiological Investigation (2005–2015)

Occupational Risk of Low-Level Blast Exposure and TBI-Related Medical Diagnoses: A Population-Based Epidemiological Investigation (2005–2015)

The Importance of Therapeutic Time Window in the Treatment of Traumatic Brain Injury

Neuroimaging of deployment-associated traumatic brain injury (TBI) with a focus on mild TBI (mTBI) since 2009

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