The DOI matches its Crossref record; 70 of the 70 references it cites were found in a registry or an index.
Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury
Open accessAbstract
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The severity of depressive symptoms following concussion is strongly correlated with global disability, rate of recovery, and quality of life (4, 10, 11).”
From Adaptive trial for the treatment of depressive symptoms associated with concussion using accelerated intermittent theta burst stimulation (ADEPT): rationale, design and methods (2025) · cites this paper as [4]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Military service members (SMs) and veterans who have sustained one or more concussions during their service have significantly higher rates of persistent depressive symptoms and suicidality compared to non-injured peers.”
From Adaptive trial for the treatment of depressive symptoms associated with concussion using accelerated intermittent theta burst stimulation (ADEPT): rationale, design and methods (2025) · cites this paper as [4]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Despite the common occurrence of chronic cognitive subjective symptomology after mTBI, extant research shows a lack of a consistent relationship with cognitive performance on formal neuropsychological examination, including samples of military personnel”
From Can mild traumatic brain injury alter cognition chronically? A LIMBIC-CENC multicenter study. (2023) · cites this paper as Mac Donald et al., 2017
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962
Validation of the Insomnia Severity Index as an outcome measure for insomnia research
Bastien, C. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(00)00065-4 · Cited by 8,067
The brief symptom inventory: an introductory report.
Derogatis, L. R., & Melisaratos, N. (1983) · Psychological Medicine · doi:10.1017/s0033291700048017 · Cited by 6,650
The development of a Clinician-Administered PTSD Scale
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995) · Journal of Traumatic Stress · doi:10.1002/jts.2490080106 · Cited by 5,024
Relaxing the Rule of Ten Events per Variable in Logistic and Cox Regression
Vittinghoff, E., & McCulloch, C. E. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwk052 · Cited by 4,359
The Michigan Alcoholism Screening Test: The Quest for a New Diagnostic Instrument
Selzer, M. L. (1971) · American Journal of Psychiatry · doi:10.1176/ajp.127.12.1653 · Cited by 3,431
Information Theory and an Extension of the Maximum Likelihood Principle
Akaike, H. (1992) · Springer Series in Statistics · doi:10.1007/978-1-4612-0919-5_38 · Cited by 3,028
Mild traumatic brain injury in U.S. soldiers returning from Iraq
Hoge, C. W., McGurk, D., Thomas, J. L., Cox, A. L., Engel, C. C., & Castro, C. A. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa072972 · Cited by 2,775
WILSON, J. T. L., PETTIGREW, L. E. L., & TEASDALE, G. M. (1998) · Journal of Neurotrauma · doi:10.1089/neu.1998.15.573 · Cited by 2,386
Clinician-administered PTSD scale: A review of the first ten years of research
Weathers, F. W., Keane, T. M., & Davidson, J. R. T. (2001) · Depression and Anxiety · doi:10.1002/da.1029 · Cited by 1,903
Flagged first, then by citations
Cited by
Sorted by citations
Items 101–143 of 143
Clark, J. M. R., Mahmood, Z., Jak, A. J., Huckans, M. S., O'Neil, M. E., Roost, M. S., Williams, R. M., Turner, A. P., Pagulayan, K. F., Storzbach, D. M., et al. (2021) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000748 · Cited by 4
O’Connell, C. J., Reeder, E. L., Collins, S. M., Lungani, K., Norman, S. V., & Robson, M. J. (2022) · Neuroreport · doi:10.1097/wnr.0000000000001822 · Cited by 4
Feng, Q., Huang, Z., Wang, Y., & Wang, B. (2024) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2024.049010 · Cited by 5
Garcia, G. S. P., Perez, G. M., Otero‐Pagan, A., Abutarboush, R., Kawoos, U., Gasperi, R. D., Sosa, M. A. G., Pryor, D., Hof, P. R., Cook, D. G., et al. (2021) · Neurotrauma Reports · doi:10.1089/neur.2021.0005 · Cited by 5
Jitsu, M., Niwa, K., Suzuki, G., Obara, T., Iwama, Y., Hagisawa, K., Takahashi, Y., Matsushita, Y., Takeuchi, S., Nawashiro, H., et al. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.621546 · Cited by 5
Strengthening goal-directed functioning after traumatic brain injury
Chen, A. J.-W., & Loya, F. (2019) · Handbook of clinical neurology · doi:10.1016/b978-0-12-804281-6.00023-9 · Cited by 4
Epshtein, E., Shraga, S., Radomislensky, I., Martindale, S. L., Bushinsky, S., Benov, A., Almog, O., Tsur, A. M., Talmy, T., Bahouth, H., et al. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.03.026 · Cited by 4
Bhatnagar, S., Anderson, M., Chu, M. P., Kuo, D., & Azuh, O. (2019) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2018.08.014 · Cited by 2
Interventions to Improve Cognitive Functioning After Traumatic Brain Injury (TBI)
Chen, A., Novakovic-Agopian, T., & Loya, F. (2019) · Springer eBooks · doi:10.1007/978-3-030-22436-3_17 · Cited by 5
Garcia, G. S. P., Perez, G. M., Gasperi, R. D., Sosa, M. A. G., Abutarboush, R., Kawoos, U., Zhu, C. W., Toro, C. A., Hof, P. R., Ahlers, S. T., et al. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1666737 · Cited by 2
Qiu, J. Y., Yang, G., Cai, J., Chen, C., Liang, S., Huang, H., & MA, L. (2026) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2026.106273 · Cited by 2
Jaramillo, C. A., Tapia, R. N., & Eapen, B. C. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-54947-9.00146-2 · Cited by 2
Veterans Traumatic Brain Injuries and Neurosurgical Challenges: A Narrative Review
Mortezaei, A., Safari, N., Gholamshahi, H., Kazemzadeh, K., & Tafakhori, A. (2025) · Health Science Reports · doi:10.1002/hsr2.70863 · Cited by 5
Turner, S. M., Kiser, S., Gipson, B. J., Martin, E. M., & Smith, J. M. (2022) · Journal of Neurotrauma · doi:10.1089/neu.2022.0237 · Cited by 2
Wofford, K. L., Grovola, M. R., Adewole, D. O., Browne, K. D., Putt, M. E., O’Donnell, J. C., & Cullen, D. K. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.02.09.430268 · Cited by 2
MacDonald, C. L., Barber, J. K., Hunt, D., Andre, J. B., Fann, J. R., Dams-O’Connor, K., & Temkin, N. R. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.47954 · Cited by 1
Self-citationResearch progress on biomarkers of traumatic brain injury
Shen, X., Cheng, S., Chen, S., Wang, M., Li, T., Xu, W., Zhang, Y., Yuan, P., & Shi, L. (2026) · Animal Models and Experimental Medicine · doi:10.1002/ame2.70173 · Cited by 1
Garcia, G. S. P., Perez, G. M., Gasperi, R. D., Sosa, M. A. G., Yeung, S., Zhu, C. W., Hof, P. R., Pan, J., Khalique, S., Kozlenkov, A., et al. (2026) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2026.1894226 · Cited by 1
Ethical considerations in the management of military related concussion
Armistead‐Jehle, P. (2018) · Military Psychology · doi:10.1080/08995605.2018.1503000 · Cited by 1
Mild TBI and Co-Occurring PTSD Symptoms in Service Member Populations
Wolf, J., Mielke, J. B., & Wolf, J. M. (2019) · Springer eBooks · doi:10.1007/978-3-030-22436-3_13 · Cited by 3
Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review
Kelter, B. M., Wolfe, A. E., Kazis, L. E., Ryan, C. M., Acton, A., Slavin, M. D., & Schneider, J. C. (2022) · Journal of Burn Care & Research · doi:10.1093/jbcr/irab245 · Cited by 1
Loya, F., Binder, D., Rodriguez, N., Buchanan, B., Novakovic-Agopian, T., & Chen, A. J.-W. (2025) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2025.1593246 · Cited by 1
Exploring the factor structure of a battery of neuropsychological assessments among the CENC cohort
Hirsch, S. C., Belanger, H. G., Levin, H. S., Eggleston, B. S., Wilde, E. A., McDonald, S. D., Brearly, T. W., & Tate, D. F. (2018) · Brain Injury · doi:10.1080/02699052.2018.1492738 · Cited by 1
Clinical Trajectories of Mild Traumatic Brain Injury
Tapia, R. N., Eapen, B. C., & Cifu, D. X. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-812344-7.00002-9 · Cited by 1
Oberman, L. M., Penafiel, A. I., Dieterich, R., Phan, C. T., Chou, Y.-Y., Pham, D. L., Adamson, M. M., Hines, C. E., Rezaee, Z., Deng, Z.-D., et al. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1605157
Mild Traumatic Brain Injury and Mental Health
Smith, L. A. G., & Vipler, B. S. (2017) · JAMA Neurology · doi:10.1001/jamaneurol.2017.2768
Mild Traumatic Brain Injury and Mental Health—Reply
Donald, C. L. M., Fann, J. R., & Temkin, N. R. (2017) · JAMA Neurology · doi:10.1001/jamaneurol.2017.2771
Self-citationÇIKRIKLAR, H. İ., Durak, V. A., ALKAN, T., Aydin, B., Sığırlı, D., SALCI, H., & Armağan, E. (2021) · Uludağ Üniversitesi Tıp Fakültesi Dergisi · doi:10.32708/uutfd.938519
Shaikh, M. A., Shah, I., & Mehmood, K. (2021) · Pakistan Journal of Medical and Health Sciences · doi:10.53350/pjmhs2115113527
Unraveling of Brain Networks in Neurological Conditions
Hoffmann, M. W. (2019) · Cambridge University Press eBooks · doi:10.1017/9781108589246.008
Shaikh, M. A., Shah, I., & Mehmood, K. (2022) · Pakistan Journal of Medical and Health Sciences · doi:10.53350/pjmhs20221611407
Introduction to Explosions and Blasts
Stenson, B. A., & Joseph, J. W. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-80932-0.00075-6
Muresanu, D. F., Sharma, A., Tian, Z. R., Lafuente, J. V., Nozari, A., Feng, L., Buzoianu, A. D., Wiklund, L., & Sharma, H. S. (2023) · Advances in neurobiology · doi:10.1007/978-3-031-32997-5_6
The effect of traumatic injuries on the nervous system
Ferreira, L. A., Tandon, I., & Balachandran, K. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-95730-4.00004-4
Biological Effects of a Shock Wave Relating to Blast Injuries
Kawauchi, S., & Sato, S. (2024) · The Review of High Pressure Science and Technology · doi:10.4131/jshpreview.34.183
Monti, K. S., Williams, K., Ivins, B. J., Uomoto, J. M., Skarda-Craft, J., & Dretsch, M. N. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1564657
Sloane, K. L., Nelson, L. D., Stein, M. B., Barber, J. K., Temkin, N. R., Scott, J. C., Brett, B. L., Manley, G. T., & Schneider, A. L. C. (2025) · BMJ Mental Health · doi:10.1136/bmjment-2025-302080
Self-citationWofford, K. L., Purvis, E. M., Acero, V. P., Gao, J., Rivellini, O. M., Kuo, E., Mietus, C. J., Browne, K. D., O’Donnell, J. C., & Cullen, D. K. (2026) · Acta Neuropathologica Communications · doi:10.1186/s40478-026-02309-8
Schilling, K. M., Talbert, L. D., Valocchi, E., Lopez, F. V., & Merritt, V. C. (2026) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001187
Guerra, M. F., Jaramillo, C. A., Tapia, R. N., & Eapen, B. C. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-23516-0.00143-4
Emery, J. B., Matheson, L. N., Shaw, O., Mannan, N., Cota, M. R., Fu, A., Haight, T. J., & Brody, D. L. (2026) · medRxiv · doi:10.64898/2026.09.24.26363933
Garcia, G. S. P., Perez, G. M., Gasperi, R. D., Sosa, M. A., Zhu, C. W., Yeung, S., Khalique, S., Toro, C. A., Hof, P. R., & Elder, G. A. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1830745
Metadata
- 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)
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2017-07-01
- Volume
- 74
- Issue
- 7
- Pages
- 821
- ISSN
- 2168-6149 (ISSN-L)
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
