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

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 access
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
Open this paper in CoChat — free accountOpen PDF

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.

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.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamaneurol.2017.0143

Cites

70 of 70 references verified0 citation errors · 0 not checkable

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.

A few free checks a day · papers already verified open instantly · results are public

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?

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

Cited by

Sorted by citations

See all 143

Related

See all

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)
ORCID
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
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