Citation

Macdonald CL, Johnson AM, Wierzechowski L, Kassner E, Stewart T, Nelson EC, Werner NJ, Adam OR, Rivet DJ, Flaherty S, Oh JS, Zonies D, Fang R, Brody DL. J. Neurotrauma 2016; 34(14): 2206-2219.

Affiliation

Washington University, Neurology , Box 8111 , 660 S. Euclid Ave. , St Louis, Missouri, United States , 63110 ; brodyd@neuro.wustl.edu.

Copyright

(Copyright © 2016, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2016.4434

PMID

27198861

Abstract

Care for US Military personnel with combat-related concussive traumatic brain injury (TBI) has substantially changed in recent years, yet trends in clinical outcomes remain largely unknown. Our prospective longitudinal studies of US Military personnel with concussive TBI from 2008-2013 at Landstuhl Regional Medical Center in Germany and 2 sites in Afghanistan provided an opportunity to assess for changes in outcomes over time and analyze correlates of overall disability. We enrolled 321 active-duty US Military personnel who sustained concussive TBI in theater and 254 Military controls. We prospectively assessed clinical outcomes 6-12 months later in 199 with concussive TBI and 148 controls. Global disability, neurobehavioral impairment, depression severity, and post-traumatic stress disorder (PTSD) severity were worse in concussive TBI groups in comparison to controls in all cohorts. Global disability primarily reflected a combination of work-related and non-work-related disability. There was a modest but statistically significant trend towards less PTSD in later cohorts. Specifically there was a decrease of 5.9 points out of 136 possible on the Clinician Administered PTSD Scale (-4.3%) per year (95% confidence interval 2.8 to 9.0 points, p=0.0037 linear regression, p=0.03 including covariates in generalized linear model). No other significant trends in outcomes were found. Global disability was more common in those with TBI, those evacuated from theater, and those with more severe depression and PTSD. Disability was not significantly related to neuropsychological performance, age, education, self-reported sleep deprivation, injury mechanism or date of enrollment. Thus, across multiple cohorts of US Military personnel with combat-related concussion, 6-12 month outcomes have improved only modestly and are often poor. Future focus on early depression and PTSD after concussive TBI appears warranted. However, adverse outcomes are incompletely explained, and additional studies will be required to fully address the root causes of persistent disability after wartime injury.

Language: en