Bottom Line: Military personnel with concussive traumatic brain injury (TBI) caused by a blast or a nonblast-related event had similar outcomes, including headache severity and depression.
Author: Christine L. Mac Donald, Ph.D., of the Washington University School of Medicine, St. Louis, and colleagues.
Background: It has been estimated that in the U.S. military about 20 percent of the deployed force experienced a head injury in the wars in Iraq and Afghanistan. Of those injured, about 83 percent had a mild, uncomplicated TBI or concussion. Blast injuries were the signature injuries of those wars. However, it remains unclear whether differences exist between blast-related TBIs and TBIs due to other causes.
How the Study Was Conducted: The study enrolled 255 patients at Landstuhl Regional Medical Center in Germany after they were medically evacuated from combat. Four groups of patients were studied: blast plus impact TBI, nonblast-related TBI with injury due to other causes, blast-exposed control patients evacuated for other reasons and nonblast-exposed control patients evacuated for other medical reasons . All patients with TBI met the criteria for concussive (mild) TBI. Patients were evaluated six to 12 months after injury.
Results: The authors found that headache severity, global outcomes, neuropsychological performance, posttraumatic stress disorder (PTSD) severity and depression were "indistinguishable" between the two TBI groups. The two TBI groups also had higher rates of moderate to severe disability compared with control patients.
Discussion: "Based on this prospective study of evacuated U.S. military personnel, we conclude that the clinical outcomes after blast-related concussive TBI are generally similar to those after nonblast-related concussion sustained during deployment. The rate of disability seen after both blast-related and nonblast-related concussive TBI is much higher than that in otherwise comparable civilian studies, which may be owing to common elements involved in TBI in a deployed setting rather than the mechanisms of injury per se."
(JAMA Neurol. Published online June 16, 2014. doi:10.1001/.jamaneurol.2014.1114. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: The study was funded by a grant from the Congressionally Directed Medical Research Program. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Media Advisory: To contact corresponding author David L. Brody, M.D., Ph.D., call Judy Martin at 314-286-0105 or email martinju@wustl.edu.
Journal
JAMA Neurology