Schwab Karen, Terrio Heidi P, Brenner Lisa A, Pazdan Renee M, McMillan Henry P, MacDonald Margaret, Hinds Sidney R, Scher Ann I
From The Defense and Veterans Brain Injury Center (K.S., H.P.T., R.M.P., M.M., S.R.H.), Silver Spring; Department of Preventive Medicine and Biostatistics (K.S., A.I.S.), Uniformed Services University, Bethesda, MD; Evans Army Community Hospital (H.P.T., R.M.P., M.M.), Fort Carson; Rocky Mountain Mental Illness Research Education and Clinical Center (L.A.B.), Denver; Anschutz Medical Campus (L.A.B.), University of Colorado, Aurora; and Intrepid Spirit (H.P.M.), Defense and Veterans Brain Injury Center, Fort Bragg, NC. Current affiliations: Bureau of Prison-Federal Medical Center (H.P.M.), Butner, NC; United States Army Medical Research and Material Command (S.R.H.).
Neurology. 2017 Apr 18;88(16):1571-1579. doi: 10.1212/WNL.0000000000003839. Epub 2017 Mar 17.
Mild traumatic brain injury (mTBI; concussion) is common in returning service members yet limited definitive evidence exists on its prognosis.
Almost 25,000 non-medically evacuated soldiers returning from Afghanistan or Iraq to 2 military bases between 2009 and 2014 were screened for mTBI. We invited a random sample to participate in the present study, oversampling those screening positive, resulting in 557 mTBI cases and 1,010 controls, of whom 366 cases and 599 controls completed 3-month follow-up evaluations. The criterion measure of screened mTBI was the Ohio State University Traumatic Brain Injury Identification Method. Postconcussive symptoms (PCS) were measured at follow-up with the Neurobehavioral Symptom Inventory. Symptoms reported at a severe or very severe level were considered clinically relevant.
About half (47%) of soldiers who had sustained an mTBI during this latest deployment reported PCS at 3-month follow-up vs 25% of controls: adjusted odds ratio 2.4 (1.8-3.2). The most commonly reported symptoms (cases vs controls) were sleep problems (30% vs 14%), forgetfulness (21% vs 9%), irritability (17% vs 8%), and headaches (15% vs 5%). mTBI cases were about twice as likely as controls to report receiving rehabilitative services and fair or poor health. Other predictors of PCS included posttraumatic stress, combat exposure, and noncephalic pain. A majority of both cases and controls reported traumatic brain injuries predating this latest deployment.
In this nonclinical population of recently deployed soldiers, a substantial proportion of those who had sustained an mTBI were symptomatic 3 months postdeployment. Future studies need to include longer follow-up to measure symptom resolution.
NCT01847040.
轻度创伤性脑损伤（mTBI；脑震荡）在退伍军人中很常见，但关于其预后的确切证据有限。
2009年至2014年间，对从阿富汗或伊拉克返回2个军事基地的近25000名未接受医疗后送的士兵进行了mTBI筛查。我们邀请了一个随机样本参与本研究，对筛查呈阳性的人进行过度抽样，结果有557例mTBI病例和1010名对照，其中366例病例和599名对照完成了3个月的随访评估。筛查mTBI的标准测量方法是俄亥俄州立大学创伤性脑损伤识别方法。随访时用神经行为症状量表测量脑震荡后症状（PCS）。报告为严重或非常严重程度的症状被视为具有临床相关性。
在最近一次部署期间遭受mTBI的士兵中，约一半（47%）在3个月随访时报告有PCS，而对照组为25%：调整后的优势比为2.4（1.8 - 3.2）。最常报告的症状（病例组与对照组）为睡眠问题（30%对14%）、健忘（21%对9%）、易怒（17%对8%）和头痛（15%对5%）。mTBI病例报告接受康复服务以及健康状况为一般或较差的可能性约为对照组的两倍。PCS的其他预测因素包括创伤后应激、战斗暴露和非头部疼痛。大多数病例组和对照组报告在最近一次部署之前有过创伤性脑损伤。
在这个最近部署的士兵非临床人群中，相当一部分遭受mTBI的人在部署后3个月有症状。未来的研究需要包括更长时间的随访以测量症状缓解情况。
NCT01847040。
