Publication year
2012
Citation Title
Influence of bodily injuries on symptom reporting following uncomplicated mild traumatic brain injury in U.S. Military service members.
Journal Name
Journal of Head Trauma Rehabilitation
Journal Volume
27
Issue Number
1
Page Numbers
63-74
DOI
10.1097/HTR.obo13e3182248344
Summary
Combat-injured Service members diagnosed with mild traumatic brain injury participated in a study examining the relationships among bodily injuries, traumatic stress, and post-concussion symptoms. There was a significant negative relationship between bodily injury scores and both posttraumatic stress disorder (PTSD) and post-concussion scores.
Key Findings
Individuals who sustained the most extensive bodily injuries reported fewer traumatic stress and post-concussion symptoms compared to those who experienced fewer bodily injuries.
Individuals in the severe/critical injury category had the lowest rates of all groups for meeting diagnostic criteria for both post-concussive disorder and PTSD.
Forty-seven percent of those in the minor injury group, 33% in the moderate, 28% in the serious, and 9% in the severe/critical group met criteria for PTSD at the moderate or greater level.
Sixty-five percent of those in the minor injury group, 50% in the moderate, 38% in the serious and 22% in the severe/critical group met criteria for PTSD at the mild or greater level.
Implications for Program Leaders
Offer classes for Service members who have experienced mild traumatic brain injury, offering skills in organizing, planning, and emotion regulation
Provide curricula for families of Service members on the symptoms of mild traumatic brain injury and referral resources
Offer support services to families of Service members who have suffered a traumatic brain injury
Implications for Policy Makers
Develop programming that disseminates information on the benefits of screening all returning Service members for mild traumatic brain injury
Encourage the development and continuation of programs that can promote resilience in Service members, their partners and children
Encourage collaboration among DoD programs and community-based organizations to support a smooth transition during reintegration for Service members who have suffered a traumatic brain injury
Methods
Patients diagnosed with an uncomplicated, closed mild traumatic brain injury at Walter Reed Army Medical Center following OEF/OIF were recruited; recruitment rates and methods were unspecified.
Criteria for uncomplicated mild traumatic brain injury was based on post-traumatic amnesia of less than 24 hours, loss of consciousness of less than 15 minutes, and the absence of intracranial abnormality on scan.
The participants completed measures of post-concussion symptoms and PTSD, and the examining physician completed an anatomically based global severity of injury. Service members divided into four groups based on severity of injury: minor, moderate, serious, and severe/critical injuries.
Statistical analyses examined the relationships among bodily injury severity and post-concussion symptoms.
Participants
One hundred thirty-seven Service members participated (100% male); the average age of the sample was 26.60 years (SD = 6.60 years).
The average time since injury was 2.50 months (SD = 3.30 months), and average number of deployments was 1.10 (SD = 0.30).
Eighty-five percent of the injuries resulted from blast exposure, and 92% happened as a part of deployment to Iraq.
No information on service branch, years in the military, and race/ethnicity were presented.
Limitations
The post-concussion and PTSD measures were self-reported and may be suceptible to biased or under-reporting.
The evaluation took place soon after injury and may have been before PTSD symptoms emerged as it takes three months of symptoms before individuals can be diagnosed with PTSD.
It is unknown if these findings would apply to individuals who had experienced the injury further in the past (average time since injury was 2.5 months).
Avenues for Future Research
Examine these outcomes longitudinally to assess if the results vary over time
Use non-self-report mental health measures and a validity measure in order to strengthen these findings
Evaluate this outcomes with a comparison group of Service members who have never been diagnosed with a traumatic injury
Focus
Army
Population Focus
Military Branch
Abstract
Objective: To examine the relations among bodily injuries, traumatic stress, and postconcussion symptoms in a sample of combat-injured US service members who sustained a mild traumatic brain injury. Participants: One hundred and thirty-seven service members evaluated and treated at Walter Reed Army Medical Center following medical evacuation from the combat theater of Operation Enduring Freedom and Operation Iraqi Freedom. All had sustained an uncomplicated mild traumatic brain injury and concurrent bodily injuries. Procedure: Participants completed 2 symptom checklists within 3 months of injury. Severity of bodily injuries was quantified with a modified version of the Injury Severity Score that excluded intracranial injuries (ISSmod). Participants were classified into 4 ISSmod groups: minor (n = 17), moderate (n = 48), serious (n = 40), severe/critical (n = 32). Main outcome measures: Neurobehavioral Symptom Inventory (NBSI) and the Posttraumatic Stress Disorder Checklist-Civilian version (PCLC). Results: There was a significant negative association between ISSmod scores and the NBSI and PCLC total scores. There were significant main effects across the 4 groups for the NBSI and PCLC total scores. The highest NBSI and PCLC scores were consistently found in the ISSmod minor group, followed by the moderate, serious, and severe/critical groups. Conclusions: While it might be expected that greater comorbid physical injuries would be associated with greater symptom burden, in this study as the severity of bodily injuries increased, symptom burden decreased. Hypothesized explanations include: underreporting of symptoms; increased peer support; disruption of fear conditioning due to acute morphine use; or delayed expression of symptoms.
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