Cited by 143Traumatic Brain Injury ResearchTraumatic Brain Injury and Neurovascular DisturbancesAutomotive and Human Injury Biomechanics

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Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury

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Mac Donald, Christine L., Barber, Jason, Jordan, Mary, Johnson, Ann M., Dikmen, Sureyya, Fann, Jesse R., Temkin, Nancy·2017·JAMA Neurology

DOI 10.1001/jamaneurol.2017.0143PMC PMC5732492

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Abstract

Importance: The long-term clinical effects of wartime traumatic brain injuries (TBIs), most of which are mild, remain incompletely described. Current medical disability cost estimates from world conflicts continually surpass projections. Additional information regarding long-term functional trajectory is needed to reduce this extensive public health burden. Objectives: To examine 5-year clinical outcomes leveraging existing clinical data collected at 1 year after injury in the same patients and to identify early risk factors for long-term disability. Design, Setting, and Participants: This prospective, longitudinal study enrolled active-duty US military after concussive blast injury (n = 50) in the acute to subacute stage and combat-deployed control individuals (n = 44) in Afghanistan or after medical evacuation to Germany from November 1, 2008, through July 1, 2013. One- and 5-year clinical evaluations were completed in the United States. All concussive blast injuries met the Department of Defense definition of mild, uncomplicated TBI. In-person clinical evaluations included standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden that were essentially identical to the evaluations completed at 1-year follow-up. Data were analyzed from October 1 through November 30, 2016. Main Outcomes and Measures: Changes in the in-person standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden from the 1- to 5-year follow-up. Predictive modeling was used to identify early risk factors for long-term disability. Results: Among the 94 participants (87 men [93%] and 7 women [7%]; mean [SD] age, 34 [8] years), global disability, satisfaction with life, neurobehavioral symptom severity, psychiatric symptom severity, and sleep impairment were significantly worse in patients with concussive blast TBI compared with combat-deployed controls, whereas performance on cognitive measures was no different between groups at the 5-year evaluation. Logistic regression on the dichotomized Extended Glasgow Outcome Scale (GOS-E) at 5 years as a measure of overall disability identified brain injury diagnosis, preinjury intelligence, motor strength, verbal fluency, and neurobehavioral symptom severity at 1 year as risk factors for a poor outcome at 5 years, with an area under the curve of 0.92 indicating excellent prediction strength. Thirty-six of 50 patients with concussive blast TBI (72%) had a decline in the GOS-E from the 1- to 5-year evaluations, in contrast with only 5 of 44 combat-deployed controls (11%). Worsening of symptoms in concussive blast TBI was also observed on measures of posttraumatic stress disorder and depression. Service members with concussive blast TBI experienced evolution, not resolution, of symptoms from the 1- to 5-year outcomes. Conclusions and Relevance: Considerable decline was observed in military service members with concussive blast TBI when comparing 1- and 5-year clinical outcomes. These results advocate for new treatment strategies to combat the long-term and extremely costly effect of these wartime injuries.

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Authors: Mac Donald, C. L., Barber, J., Jordan, M., Johnson, A. M., Dikmen, S., Fann, J. R., & Temkin, N.
Affiliations: Department of Neurological Surgery, University of Washington, Seattle
University of Washington (US)
Washington University in St. Louis (US)
ORCID: Barber, Jason
Fann, Jesse R.
Temkin, Nancy
Venue: JAMA Neurology
Publisher: American Medical Association (AMA)
Published: 2017-07-01
Volume: 74
Issue: 7
Pages: 821
ISSN: 2168-6149 (ISSN-L)
DOI: 10.1001/jamaneurol.2017.0143
PMC: PMC5732492
OpenAlex: W2611287086
Cited by: 142
References: 70
Citations by year: 2026: 8 · 2025: 11 · 2024: 12 · 2023: 10 · 2022: 14 · 2021: 18 · 2020: 21 · 2019: 21 · 2018: 19 · 2017: 7
FWCI: 14.57
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA Neurology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: U.S. Department of Defense (W81XWH1320095, W81XWH, W81XWH-13-2-, W81XWH-13)
National Institutes of Health (W81XWH)
National Institute of Neurological Disorders and Stroke (R01NS091618)
Topics: Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Physical Sciences › Engineering › Biomedical Engineering › Automotive and Human Injury Biomechanics
Keywords: mild traumatic brain injury, military personnel, long-term disability, risk factors, neurobehavioral symptoms, sleep disorders, psychiatric symptoms, life satisfaction, cognitive function, Glasgow Outcome Scale-Extended, functional outcome prediction, neuropsychological performance, motor strength, verbal fluency, war-related brain injury, Afghanistan deployment
MeSH terms: Adult, Behavioral Symptoms, Blast Injuries, Brain Concussion, Female, Humans, Longitudinal Studies, Male, Migraine Disorders, Military Personnel, Prognosis, Risk Factors, United States, Case-Control Studies, Outcome Assessment, Health Care, Glasgow Outcome Scale, Afghan Campaign 2001-, Cognitive Dysfunction

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Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury

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