Acute post-traumatic stress symptoms and age predict outcome in military blast concussion
Brain: A Journal of Neurology 2015: 138, 1314-1326, (article downloaded 23 March 2018).
20% of the deployed service persons in Iraq and Afghanistan sustained a head injury of some type. It is estimated that upwards of 1.9 million to 3 million services members deployed to Iraq and Afghanistan since 9/11 with as many as half deploying more than once. This would mean that there were as many as 380,000 to 600,000 distinct head injuries. Of these 83% had mild TBI or concussions. So somewhere between 315,400 to 498,000 concussion treatments would have been needed.
This study evaluated what happened to the concussed individuals of time. Specifically, 6-12 months after return to the U.S. the researchers wanted to know if the measurements that were used at the time of diagnosis could predict long term brain effects.
Methods:
72 individuals were randomly selected to participate – a control group of non-concussed persons, (34) and concussed persons, (38). Each person was evaluated for concussion while Afghanistan and then followed up 6-12 months later at Washington University in Saint Louis. There were no abnormal findings on CT scans of the brain of participants. Each had screened as negative history of TBI prior to deployment to Afghanistan.
There were 6 questionnaires for concussion and 1 for depression used. At the 6–12-month follow-up individuals received neurologic examination, psychiatric evaluation, screenings for new head injury that may have resulted in loss of consciousness or amnesia.
Regression analysis was used to determine with independent measured criteria had some relationship.
Results:
Evaluations conducted 0-7 days post injury showed that individuals diagnosed with concussion had more severe symptoms and worse performance on testing than the group that had not been diagnosed with concussion, (the controls). There tended to be more concussion symptoms as would be expected, but there was more depression and PTSD issues. Interestingly, there was a slight correlation of balance and postural problems between control and concussion groups.
At 6–12-month follow-up, the TBI group continued to have long term issues that were not anticipated by this study. Headaches were worse. Some concussed persons continued to have difficulty thinking clearly. Depression and PTSD was higher in the concussed group as well at 6-12 months.
What to take from paper:
The immediate evaluations used at the time of injury for concussion or mild TBI could not predict the long-term issues experienced by service members once they returned state side.
Those immediate assessments included: Military Acute Concussion Evaluation, (MACE); Rivermead Post-Concussion Symptom Questionnaire,(RPCSQ); Post-traumatic Stress Disorder Check List Military, (PCL-M); Beck Depression Inventory; Combat Exposures Scale, (CES); Balance Error Scoring System, (BESS); Automated Neurocognitive Assessment Metrics – Traumatic Brain Injury Military Version 4, (ANAM); Test of Memory Malingering, (TOMM).
