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Understanding Sequelae of Injury Mechanisms and Mild Traumatic Brain Injury Incurred during the Conflicts in Iraq and Afghanistan: Persistent Postconcussive Symptoms and Posttraumatic Stress Disorder

War-Related Illness and Injury Study Center, Washington DC VA Medical Center, Washington, DC 20422, USA.
American journal of epidemiology (Impact Factor: 4.98). 07/2008; 167(12):1446-52. DOI: 10.1093/aje/kwn068
Source: PubMed

ABSTRACT A cross-sectional study of military personnel following deployment to conflicts in Iraq or Afghanistan ascertained histories of combat theater injury mechanisms and mild traumatic brain injury (TBI) and current prevalence of posttraumatic stress disorder (PTSD) and postconcussive symptoms. Associations among injuries, PTSD, and postconcussive symptoms were explored. In February 2005, a postal survey was sent to Iraq/Afghanistan veterans who had left combat theaters by September 2004 and lived in Maryland; Washington, DC; northern Virginia; and eastern West Virginia. Immediate neurologic symptoms postinjury were used to identify mild TBI. Adjusted prevalence ratios and 95% confidence intervals were computed by using Poisson regression. About 12% of 2,235 respondents reported a history consistent with mild TBI, and 11% screened positive for PTSD. Mild TBI history was common among veterans injured by bullets/shrapnel, blasts, motor vehicle crashes, air/water transport, and falls. Factors associated with PTSD included reporting multiple injury mechanisms (prevalence ratio = 3.71 for three or more mechanisms, 95% confidence interval: 2.23, 6.19) and combat mild TBI (prevalence ratio = 2.37, 95% confidence interval: 1.72, 3.28). The strongest factor associated with postconcussive symptoms was PTSD, even after overlapping symptoms were removed from the PTSD score (prevalence ratio = 3.79, 95% confidence interval: 2.57, 5.59).

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Available from: Elisa R Braver, Jan 16, 2014
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    • "The symptoms shared among mild TBI, PTSD and depression include, for example , headache, insomnia, fatigue, irritability, cognitive dysfunction , and chronic pain (Hoge et al. 2008; Iverson 2005), all which can be considered independently existing clinical processes or as components of a complex syndrome (Scholten et al. 2012). These symptoms and conditions also frequently co-occur, which further complicates clinical understanding and may ultimately impede treatment and recovery (Carlson et al. 2010, 2011; Hill et al. 2009; Schneiderman et al. 2008; Vanderploeg et al. 2012; Vanderploeg 2007; Walker et al. 2012). Despite the complex comorbidity of these conditions, the current clinical practice guideline for treatment of mild TBI (concussion) calls for single disease focused treatment and symptom-based management (Management of Concussion/ mTBI Working Group 2009). "
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