Department of Medical Modeling, Simulation, and Mission Support, San Diego, CA 92106, USA.
J Neurotrauma. 2013 Aug 15;30(16):1391-7. doi: 10.1089/neu.2012.2537. Epub 2013 Jul 17.
Assessment of acute mild traumatic brain injury (mTBI) symptoms after a combat blast could aid diagnosis and guide follow-up care. Our objective was to document acute mTBI symptoms following a combat blast and to examine associations between acute symptoms and mental health and service discharge outcomes. A retrospective cohort study was conducted with 1656 service personnel who experienced a combat blast-related mTBI in Iraq. Acute mTBI symptoms were ascertained from point-of-injury medical records. The associations between acute symptoms and posttraumatic stress disorder (PTSD), postconcussion syndrome (PCS), and type of service discharge were examined. Disability discharge occurred in 11% of patients, while 36% had a non-disability discharge and 52% had no recorded discharge. A PTSD and PCS diagnosis was made in 19% and 15% of the sample, respectively. The most common acute mTBI symptoms were headache (62.8%), loss of consciousness (LOC) (34.5%), and tinnitus (33.2%). LOC was predictive of PTSD (odds ratio [OR] 1.54; 95% confidence interval [CI] 1.18, 2.00) and PCS (OR 2.08; 95% CI 1.56, 2.77), while altered mental status (OR 1.53; 95% CI 1.07, 2.17) and previous blast history (OR 1.83; 95% CI 1.15, 2.90) also were predictive of PCS. While no acute mTBI symptoms were associated with discharge outcomes, injury severity was associated with disability discharge. LOC after blast-related mTBI was associated with PTSD and PCS, and injury severity was predictive of disability discharge. The assessment of cognitive status immediately after a blast could assist in diagnosing mTBI and indicate a need for follow-up care.
评估战斗爆炸后急性轻度创伤性脑损伤 (mTBI) 的症状有助于诊断并指导后续护理。我们的目的是记录战斗爆炸后急性 mTBI 的症状，并研究急性症状与心理健康和服务出院结果之间的关系。对 1656 名在伊拉克经历战斗爆炸相关 mTBI 的现役人员进行了回顾性队列研究。急性 mTBI 症状从伤后医疗记录中确定。研究了急性症状与创伤后应激障碍 (PTSD)、脑震荡后综合征 (PCS) 和服务出院类型之间的关系。11%的患者残疾出院，36%非残疾出院，52%无记录出院。该样本中分别有 19%和 15%的患者被诊断为 PTSD 和 PCS。最常见的急性 mTBI 症状是头痛 (62.8%)、意识丧失 (LOC) (34.5%) 和耳鸣 (33.2%)。LOC 预测 PTSD(比值比 [OR] 1.54；95%置信区间 [CI] 1.18, 2.00) 和 PCS(OR 2.08；95% CI 1.56, 2.77)，而精神状态改变 (OR 1.53；95% CI 1.07, 2.17) 和既往爆炸史 (OR 1.83；95% CI 1.15, 2.90) 也预测 PCS。虽然没有急性 mTBI 症状与出院结果相关，但损伤严重程度与残疾出院相关。爆炸相关 mTBI 后的 LOC 与 PTSD 和 PCS 相关，损伤严重程度与残疾出院相关。爆炸后立即评估认知状态有助于诊断 mTBI，并表明需要后续护理。
