Outcome Trends after US Military Concussive Traumatic Brain Injury

Christine L. Mac Donald, Ann M. Johnson, Linda Wierzechowski, Elizabeth Kassner, Theresa Stewart, Elliot C. Nelson, Nicole J. Werner, Octavian R. Adam, Dennis J. Rivet, Stephen F. Flaherty, John S. Oh, David Zonies, Raymond Fang, David L. Brody

Research output: Contribution to journalArticle

14 Citations (Scopus)

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 twp 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 with controls in all cohorts. Global disability primarily reflected a combination of work-related and nonwork-related disability. There was a modest but statistically significant trend toward less PTSD in later cohorts. Specifically, there was a decrease of 5.9 points of 136 possible on the Clinician Administered PTSD Scale (-4.3%) per year (95% confidence interval, 2.8-9.0 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. Adverse outcomes are incompletely explained, however, and additional studies with prospective collection of data on acute injury severity and polytrauma, as well as reduced attrition before follow-up will be required to fully address the root causes of persistent disability after wartime injury.

Original languageEnglish (US)
Pages (from-to)2206-2219
Number of pages14
JournalJournal of Neurotrauma
Volume34
Issue number14
DOIs
StatePublished - Jul 15 2017

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Post-Traumatic Stress Disorders
Military Personnel
Depression
Linear Models
Wounds and Injuries
Prospective Studies
Afghanistan
Sleep Deprivation
Multiple Trauma
Traumatic Brain Injury
Germany
Longitudinal Studies
Confidence Intervals
Education

Keywords

  • blast TBI
  • clinical outcomes
  • concussive TBI
  • PTSD

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Mac Donald, C. L., Johnson, A. M., Wierzechowski, L., Kassner, E., Stewart, T., Nelson, E. C., ... Brody, D. L. (2017). Outcome Trends after US Military Concussive Traumatic Brain Injury. Journal of Neurotrauma, 34(14), 2206-2219. https://doi.org/10.1089/neu.2016.4434

Outcome Trends after US Military Concussive Traumatic Brain Injury. / Mac Donald, Christine L.; Johnson, Ann M.; Wierzechowski, Linda; Kassner, Elizabeth; Stewart, Theresa; Nelson, Elliot C.; Werner, Nicole J.; Adam, Octavian R.; Rivet, Dennis J.; Flaherty, Stephen F.; Oh, John S.; Zonies, David; Fang, Raymond; Brody, David L.

In: Journal of Neurotrauma, Vol. 34, No. 14, 15.07.2017, p. 2206-2219.

Research output: Contribution to journalArticle

Mac Donald, CL, Johnson, AM, Wierzechowski, L, Kassner, E, Stewart, T, Nelson, EC, Werner, NJ, Adam, OR, Rivet, DJ, Flaherty, SF, Oh, JS, Zonies, D, Fang, R & Brody, DL 2017, 'Outcome Trends after US Military Concussive Traumatic Brain Injury', Journal of Neurotrauma, vol. 34, no. 14, pp. 2206-2219. https://doi.org/10.1089/neu.2016.4434
Mac Donald CL, Johnson AM, Wierzechowski L, Kassner E, Stewart T, Nelson EC et al. Outcome Trends after US Military Concussive Traumatic Brain Injury. Journal of Neurotrauma. 2017 Jul 15;34(14):2206-2219. https://doi.org/10.1089/neu.2016.4434
Mac Donald, Christine L. ; Johnson, Ann M. ; Wierzechowski, Linda ; Kassner, Elizabeth ; Stewart, Theresa ; Nelson, Elliot C. ; Werner, Nicole J. ; Adam, Octavian R. ; Rivet, Dennis J. ; Flaherty, Stephen F. ; Oh, John S. ; Zonies, David ; Fang, Raymond ; Brody, David L. / Outcome Trends after US Military Concussive Traumatic Brain Injury. In: Journal of Neurotrauma. 2017 ; Vol. 34, No. 14. pp. 2206-2219.
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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 twp 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 with controls in all cohorts. Global disability primarily reflected a combination of work-related and nonwork-related disability. There was a modest but statistically significant trend toward less PTSD in later cohorts. Specifically, there was a decrease of 5.9 points of 136 possible on the Clinician Administered PTSD Scale (-4.3{\%}) per year (95{\%} confidence interval, 2.8-9.0 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. Adverse outcomes are incompletely explained, however, and additional studies with prospective collection of data on acute injury severity and polytrauma, as well as reduced attrition before follow-up will be required to fully address the root causes of persistent disability after wartime injury.",
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