Citation

Macdonald CL, Johnson AM, Nelson EC, Werner NJ, Fang R, Flaherty S, Brody DL. J. Neurotrauma 2014; 31(10): 889-898.

Affiliation

Washington University, Department of Neurology, 660 South Euclid, Box 8111, St. Louis, Missouri, United States, 63130, 314-362-1378 ; macdonaldc@neuro.wustl.edu.

Copyright

(Copyright © 2014, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2013.3173

PMID

24367929

Abstract

Fundamental questions remain unanswered about the longitudinal impact of blast-plus-impact complex traumatic brain injuries (TBI) from wars in Iraq and Afghanistan. This prospective, observational study investigated measures of clinical outcome in US military personnel evacuated to Landstuhl Regional Medical Center (LRMC) in Germany following such 'blast-plus' concussive TBIs. Glasgow Outcome Scale-Extended assessments completed 6-12 months after injury indicated a moderate overall disability in 41/47 (87%) 'blast-plus' TBI subjects and substantial but smaller number (11/18, 61%, p=0.018) of demographically similar US military controls without TBI evacuated for other medical reasons. Cognitive function assessed with a neuropsychological test battery was not different between 'blast-plus' TBI subjects and controls; performance of both groups was generally in the normal range. No subject was found to have focal neurological deficits. However, 29/47 (57%) of 'blast-plus' TBI subjects met all criteria for post-traumatic stress disorder (PTSD) vs. 5/18 (28%) of controls (p=0.014). PTSD was highly associated with overall disability; 31/34 patients with PTSD vs. 19/31 patients that did not meet full PTSD criteria had moderate to severe disability (p=0.0003). Symptoms of depression were also more severe in the TBI group (p=0.05), and highly correlated with PTSD severity (r=0.86, p<0.0001). Thus, in summary, high rates of PTSD and depression but not cognitive impairment or focal neurological deficits were observed 6-12 months after concussive blast-plus-impact complex TBI. Overall disability was substantially greater than typically reported in civilian non-blast concussive ('mild') TBI patients, even with polytrauma. The relationship between these clinical outcomes and specific blast-related aspects of brain injuries vs. other combat-related factors remains unknown.

Language: en