Norman Rocío S, Jaramillo Carlos A, Eapen Blessen C, Amuan Megan E, Pugh Mary Jo
Speech-Language Pathology Program, School of Health Professions, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX.
South Texas Veterans Health Care System, Polytrauma Rehabilitation Center, 7400 Merton Miner Dr. San Antonio, TX.
Mil Med. 2018 Nov 1;183(11-12):e526-e534. doi: 10.1093/milmed/usy067.
Determine the association between acquired stuttering (AS), traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) in a cohort of 309,675 U.S. Iraq and Afghanistan veterans. The secondary aim was to determine the association between AS and medication patterns for veterans in the sample.
Retrospective study using data from the Veterans Health Administration National Repository for veterans deployed in support of combat operations in Iraq and Afghanistan and who received Veterans Health Administration care in 2010 and 2011. We identified stuttering using ICD-9 codes to establish the association between AS, TBI, and PTSD, controlling for demographic characteristics and other comorbidities. Multivariable logistic regression was used to determine the association between comorbid conditions and potentially problematic medications associated with stuttering.
Two hundred thirty-five veterans (0.08%) were diagnosed with AS in the cohort. There was the greater likelihood of an AS diagnosis for veterans with concomitant TBI and PTSD when compared with veterans without these diagnoses. Over 66% of those with stuttering were prescribed at least one medication that affected speech fluency (antidepressants, anxiolytics, and antiepileptic drugs) compared with 35% of those without AS.
Veterans with a comorbid diagnosis of TBI and PTSD were more likely to be diagnosed with AS AOR: 9.77 (95% CI = 6.93-13.78, p < 0.05) and more likely to have been prescribed medications known to affect speech production OR: 3.68 (95% CI = 2.81-4.82, p < 0.05). Clinicians treating veterans with these complex comorbid conditions should consider the impact of medications on speech fluency.
在309,675名美国伊拉克和阿富汗退伍军人队列中，确定获得性口吃（AS）、创伤性脑损伤（TBI）和创伤后应激障碍（PTSD）之间的关联。次要目的是确定样本中退伍军人AS与用药模式之间的关联。
采用回顾性研究，数据来自退伍军人健康管理局国家资料库，该资料库涵盖了为支持伊拉克和阿富汗作战行动而部署的退伍军人，且这些退伍军人在2010年和2011年接受了退伍军人健康管理局的护理。我们使用国际疾病分类第九版（ICD - 9）编码来识别口吃，以确定AS、TBI和PTSD之间的关联，并控制人口统计学特征和其他合并症。使用多变量逻辑回归来确定合并症与与口吃相关的潜在问题药物之间的关联。
队列中有235名退伍军人（0.08%）被诊断为AS。与未患这些疾病的退伍军人相比，同时患有TBI和PTSD的退伍军人被诊断为AS的可能性更大。口吃患者中超过66%的人至少被开了一种影响言语流畅性的药物（抗抑郁药、抗焦虑药和抗癫痫药），而无AS的患者这一比例为35%。
同时患有TBI和PTSD的退伍军人更有可能被诊断为AS（调整后比值比[AOR]：9.77，95%置信区间[CI] = 6.93 - 13.78，p < 0.05），并且更有可能被开已知会影响言语产生的药物（比值比[OR]：3.68，95% CI = 2.81 - 4.82，p < 0.05）。治疗患有这些复杂合并症退伍军人的临床医生应考虑药物对言语流畅性的影响。
