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Blast-related brain injuries

Evaluating military personnel with traumatic brain injuries, Washington University School of Medicine researchers have found that early symptoms of post-traumatic stress, such as anxiety, sadness and irritability are the strongest predictors of later disability. The results were surprising because mental health more closely correlated with disability than assessments typically made after concussions, such as tests of memory, balance, coordination, and severity of headaches.

WHEN DOCTORS EVALUATE CONCUSSIONS, THEY LOOK AT A PERSON’S BALANCE, WHETHER THAT INDIVIDUAL IS HAVING HEADACHES AND OTHER PHYSICAL SYMPTOMS OF BRAIN INJURY. BUT A NEW STUDY FROM RESEARCHERS AT WASHINGTON UNIVERSITY IN ST. LOUIS, THE NAVAL MEDICAL CENTER AND THE UNIVERSITY OF WASHINGTON IN SEATTLE, HAS FOUND THAT WHEN EVALUATING DISABILITY RISK IN MILITARY PERSONNEL WHO’VE SUFFERED CONCUSSSIONS ON THE BATTLEFIELD, IT’S IMPORTANT TO SCREEN FOR PSYCHIATRIC SYMPTOMS, TOO. JIM DRYDEN REPORTS…

EVALUATING PEOPLE WITH TRAUMATIC BRAIN INJURIES SUSTAINTED ON THE BATTLEFIELD, THE RESEARCHERS FOUND THAT EARLY MEASURES OF PSYCHIATRIC HEALTH ARE BETTER PREDICTORS OF LATER DISABILITY THAN THE TYPICAL ASSESSMENTS OF MEMORY, THINKING, BALANCE, HEADACHES AND DIZZINESS. PARTNERING WITH THE U.S. MILITARY, THE RESEARCHERS EVALUATED TRAUMATIC BRAIN INJURY FROM BLAST EXPOSURE IN ACTIVE DUTY MILITARY PERSONNEL IN AFGHANISTAN IN 2012. WASHINGTON UNIVERSITY NEUROLOGIST DAVID BRODY WAS THE STUDY’S SENIOR INVESTIGATOR.

(act) :16 o/c long-term disability

The severity of post-traumatic stress symptoms and depressive

symptoms, at very early times in the first seven days after

injury, was the strongest predictor of long-term disability.

BRODY SAYS STANDARD CONCUSSION ASSESSMENTS DIDN’T TELL THE RESEACHERS VERY MUCH ABOUT LATER PROBLEMS. INSTEAD, THOSE EARLY SYMPTOMS OF PSYCHIATRIC DISTRESS WERE THE BETTER PREDICTORS.

(act) :17 o/c strongest predictor

Previous studies have not assessed post-traumatic stress

symptoms and depressive symptoms at early times after injury.

That’s always been thought to be a late phenomenon. So we

don’t know the origin of those symptoms, but nonetheless,

the severity of those symptoms was the strongest predictor.

FIRST AUTHOR CHRISTINE MACDONALD, A RESEARCHER AT THE UNIVERSITY OF WASHINGTON IN SEATTLE, SAYS SHE WAS A BIT SURPRISED AT THE LONG-TERM IMPLICATIONS OF EARLY SYMPTOMS OF DEPRESSION AND POST-TRAUMATIC STRESS DISORDER.

(act) :24 o/c with poly-trauma

The surprising part was that these seemingly trivial

exposures had some fairly significant impact when we were

able to “connect the dots” and look at them at, you know,

six to 12 months outcome. They had surprisingly high levels

of moderate disability, especially when you compare to

comparable civilian studies of mild, or concussive brain

injury, even those with poly-trauma.

THAT IS INJURIES IN ADDITION TO CONCUSSION, LIKE BURNS OR BROKEN BONES. AND BRODY SAYS THAT STANDARD EVALUATIONS OF TRAUMATIC BRAIN INJURY IN MILITARY SERVICE PEOPLE DON’T USUALLY INCLUDE A LOOK AT SYMPTOMS OF DEPRESSION OR POST-TRAUMATIC STRESS. INSTEAD, MILITARY DOCTORS EVALUATE BLAST-RELATED TRAUMATIC BRAIN INJURIES IN THE SAME WAY THAT SPORTS MEDICINE PHYSICIANS EVALUATE CONCUSSIONS IN ATHLETES.

(act) :20 o/c long-term outcomes

Looking at assessments of cognitive function, balance

and somatic symptoms — things like headaches, dizziness.

Although those things are definitely true, those are not

the things that predicted long-term outcomes.

BRODY SAYS MORE STUDY IS NEEDED, BUT HE SAYS INCLUDING EVALUATIONS OF POST-TRAUMATIC STRESS AND DEPRESSION IN ASSESSMENTS OF MILITARY PERSONNEL WITH TRAUMATIC BRAIN INJURIES MIGHT BE A GOOD IDEA.

(act) :15 o/c right away

Post-traumatic stress and depression evaluations were not

part of the routine, clinical evaluation. Those were for

research only. One military officer who saw these results

early, before we published it, said to me, “Oh, so we’ve

got to start doing that right away.”

BRODY, MACDONALD AND THEIR COLLEAGUES REPORT THEIR FINDINGS IN THE JOURNAL BRAIN. I’M JIM DRYDEN…

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