Predictors of disability among military personnel following a traumatic blast concussion

It is no surprise that military personnel who suffer a blast related brain injury are likely to experience post-traumatic stress disorder (PTSD) and depression. A recently published study out of the University of Washington in St. Louis has shown that when these early symptoms, which include anxiety, depression, flashbacks, and PTSD, occur within one week of the injury, they are a better predictor of long term disability than the results of common tests such as memory, thinking, and balance.

The prospective, observational study enrolled 38 U.S. military members who sustained a concussive traumatic brain injury. They were compared with 34 controls. All subjects who suffered injury were evaluated within 7 days at two sites in Afghanistan. The subjects were also re-evaluated again between 6 and 12 months post injury in the U.S. Service member’s ages ranged from 19 to 44 years old. Mental health was evaluated using a standardized military post-traumatic stress disorder questionnaire. Depressive symptoms and post-traumatic stress symptoms were elevated during the initial assessments while cognitive function was worse in subjects with a traumatic concussive injury. After the 6 – 12 month assessments, 63% of the subjects had moderate overall disability versus 20% in the control group. Moderate disability in this case is defined by inability to work in the same capacity as prior to injury, are unable to engage in normal social or leisure activities, and/or have disrupted relationships secondary to mental health disturbances.

It was believed that traditional measures including memory, attention, balance, and coordination would be the best predictors of long term disability. In this study these measures were not correlated with outcomes, but rather the psychological symptoms that were better predictors. It is unknown whether the psychological symptoms result from the brain injury, from stress related to war, or from other combined factors.

Having the knowledge that symptoms of PTSD and depression start much sooner than suspected in some cases, psychological evaluations should begin earlier and allow for earlier targeted care. The long term effect of this is unknown, but may offer the best chance to improve the quality of life. Researchers from the study also are planning to apply these findings in future studies looking at concussive brain injuries in the civilian world.

This study was conducted by investigators at the University of Washington in St. Louis and The U.S. Naval Medical Center in Portsmouth, Virginia.

References:

MacDonald CL, Adam OR, Johnson AM, Nelson EC, Werner NJ, Rivet DJ, Brody DL. Acute post-traumatic stress symptoms and age predict outcome in military blast concussion. Brain. 2015 Mar 4.