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Bukowski J, Nowadly CD, Schauer SG, Koyfman A, Long B. High risk and low prevalence diseases: Blast injuries. Am J Emerg Med 2023; 70:46-56. [PMID: 37207597 DOI: 10.1016/j.ajem.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Blast injury is a unique condition that carries a high rate of morbidity and mortality, often with mixed penetrating and blunt injuries. OBJECTIVE This review highlights the pearls and pitfalls of blast injuries, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Explosions may impact multiple organ systems through several mechanisms. Patients with suspected blast injury and multisystem trauma require a systematic evaluation and resuscitation, as well as investigation for injuries specific to blast injuries. Blast injuries most commonly affect air-filled organs but can also result in severe cardiac and brain injury. Understanding blast injury patterns and presentations is essential to avoid misdiagnosis and balance treatment of competing interests of patients with polytrauma. Management of blast victims can also be further complicated by burns, crush injury, resource limitation, and wound infection. Given the significant morbidity and mortality associated with blast injury, identification of various injury patterns and appropriate management are essential. CONCLUSIONS An understanding of blast injuries can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Josh Bukowski
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Craig D Nowadly
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Steven G Schauer
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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2
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Clausen AN, Bouchard HC, Welsh-Bohmer KA, Morey RA. Assessment of Neuropsychological Function in Veterans With Blast-Related Mild Traumatic Brain Injury and Subconcussive Blast Exposure. Front Psychol 2021; 12:686330. [PMID: 34262512 PMCID: PMC8273541 DOI: 10.3389/fpsyg.2021.686330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/03/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: The majority of combat-related head injuries are associated with blast exposure. While Veterans with mild traumatic brain injury (mTBI) report cognitive complaints and exhibit poorer neuropsychological performance, there is little evidence examining the effects of subconcussive blast exposure, which does not meet clinical symptom criteria for mTBI during the acute period following exposure. We compared chronic effects of combat-related blast mTBI and combat-related subconcussive blast exposure on neuropsychological performance in Veterans. Methods: Post-9/11 Veterans with combat-related subconcussive blast exposure (n = 33), combat-related blast mTBI (n = 26), and controls (n = 33) without combat-related blast exposure, completed neuropsychological assessments of intellectual and executive functioning, processing speed, and working memory via NIH toolbox, assessment of clinical psychopathology, a retrospective account of blast exposures and non-blast-related head injuries, and self-reported current medication. Huber Robust Regressions were employed to compare neuropsychological performance across groups. Results: Veterans with combat-related blast mTBI and subconcussive blast exposure displayed significantly slower processing speed compared with controls. After adjusting for post-traumatic stress disorder and depressive symptoms, those with combat-related mTBI exhibited slower processing speed than controls. Conclusion: Veterans in the combat-related blast mTBI group exhibited slower processing speed relative to controls even when controlling for PTSD and depression. Cognition did not significantly differ between subconcussive and control groups or subconcussive and combat-related blast mTBI groups. Results suggest neurocognitive assessment may not be sensitive enough to detect long-term effects of subconcussive blast exposure, or that psychiatric symptoms may better account for cognitive sequelae following combat-related subconcussive blast exposure or combat-related blast mTBI.
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Affiliation(s)
- Ashley N. Clausen
- Kansas City VA Medical Center, Kansas City, MO, United States
- Duke-University of North Carolina at Chapel Hill Brain Imaging and Analysis Center, Duke University, Durham, NC, United States
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veteran Affairs Healthcare System, Durham, NC, United States
| | - Heather C. Bouchard
- Duke-University of North Carolina at Chapel Hill Brain Imaging and Analysis Center, Duke University, Durham, NC, United States
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veteran Affairs Healthcare System, Durham, NC, United States
| | | | | | - Rajendra A. Morey
- Duke-University of North Carolina at Chapel Hill Brain Imaging and Analysis Center, Duke University, Durham, NC, United States
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veteran Affairs Healthcare System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
- Center for Cognitive Neuroscience, Duke University, Durham, NC, United States
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Koochaki F, Shamsi F, Najafizadeh L. Detecting mTBI by Learning Spatio-temporal Characteristics of Widefield Calcium Imaging Data Using Deep Learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2917-2920. [PMID: 33018617 DOI: 10.1109/embc44109.2020.9175327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Early diagnosis of mild traumatic brain injury (mTBI) is of great interest to the neuroscience and medical communities. Widefield optical imaging of neuronal populations over the cerebral cortex in animals provides a unique opportunity to study injury-induced alternations in brain function. Using this technique, along with deep learning, the goal of this paper is to develop a framework for the detection of mTBI. Cortical activities in transgenic calcium reporter mice expressing GCaMP6s are obtained using widefield imaging from 8 mice before and after inducing an injury. Two deep learning models for differentiating mTBI from normal conditions are proposed. One model is based on the convolutional neural network-long short term memory (CNN-LSTM), and the second model is based on a 3D-convolutional neural network (3D-CNN). These two models offer the ability to capture features both in the spatial and temporal domains. Results for the average classification accuracy for the CNN-LSTM and the 3D-CNN are 97.24% and 91.34%, respectively. These results are notably higher than the case of using the classical machine learning methods, demonstrating the importance of utilizing both the spatial and temporal information for early detection of mTBI.
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Baker MT, Moring JC, Hale WJ, Mintz J, Young-McCaughan S, Bryant RA, Broshek DK, Barth JT, Villarreal R, Lancaster CL, Malach SL, Lara-Ruiz JM, Isler W, Peterson AL. Acute Assessment of Traumatic Brain Injury and Post-Traumatic Stress After Exposure to a Deployment-Related Explosive Blast. Mil Med 2019; 183:e555-e563. [PMID: 29788111 PMCID: PMC7263835 DOI: 10.1093/milmed/usy100] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are two of the signature injuries in military service members who have been exposed to explosive blasts during deployments to Iraq and Afghanistan. Acute stress disorder (ASD), which occurs within 2–30 d after trauma exposure, is a more immediate psychological reaction predictive of the later development of PTSD. Most previous studies have evaluated service members after their return from deployment, which is often months or years after the initial blast exposure. The current study is the first large study to collect psychological and neuropsychological data from active duty service members within a few days after blast exposure. Materials and Methods Recruitment for blast-injured TBI patients occurred at the Air Force Theater Hospital, 332nd Air Expeditionary Wing, Joint Base Balad, Iraq. Patients were referred from across the combat theater and evaluated as part of routine clinical assessment of psychiatric and neuropsychological symptoms after exposure to an explosive blast. Four measures of neuropsychological functioning were used: the Military Acute Concussion Evaluation (MACE); the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); the Headminder Cognitive Stability Index (CSI); and the Automated Neuropsychological Assessment Metrics, Version 4.0 (ANAM4). Three measures of combat exposure and psychological functioning were used: the Combat Experiences Scale (CES); the PTSD Checklist-Military Version (PCL-M); and the Acute Stress Disorder Scale (ASDS). Assessments were completed by a deployed clinical psychologist, clinical social worker, or mental health technician. Results A total of 894 patients were evaluated. Data from 93 patients were removed from the data set for analysis because they experienced a head injury due to an event that was not an explosive blast (n = 84) or they were only assessed for psychiatric symptoms (n = 9). This resulted in a total of 801 blast-exposed patients for data analysis. Because data were collected in-theater for the initial purpose of clinical evaluation, sample size varied widely between measures, from 565 patients who completed the MACE to 154 who completed the CES. Bivariate correlations revealed that the majority of psychological measures were significantly correlated with each other (ps ≤ 0.01), neuropsychological measures were correlated with each other (ps ≤ 0.05), and psychological and neuropsychological measures were also correlated with each other (ps ≤ 0.05). Conclusions This paper provides one of the first descriptions of psychological and neuropsychological functioning (and their inter-correlation) within days after blast exposure in a large sample of military personnel. Furthermore, this report describes the methodology used to gather data for the acute assessment of TBI, PTSD, and ASD after exposure to an explosive blast in the combat theater. Future analyses will examine the common and unique symptoms of TBI and PTSD, which will be instrumental in developing new assessment approaches and intervention strategies.
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Affiliation(s)
- Monty T Baker
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, San Antonio, TX
| | - John C Moring
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Willie J Hale
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Richard A Bryant
- School of Psychology, University of New South Wales, 11 Botany Street, Sydney, New South Wales, Australia
| | - Donna K Broshek
- Department of Psychiatry, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA
| | - Jeffrey T Barth
- Department of Psychiatry, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA
| | - Robert Villarreal
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX
| | - Cynthia L Lancaster
- Department of Psychology, University of Nevada, Reno, 1664 N Virginia Street, Reno, NV
| | - Steffany L Malach
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX
| | - Jose M Lara-Ruiz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX
| | - William Isler
- Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, San Antonio, TX
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate Highway 10 West, Suite 1325, San Antonio, TX.,Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX.,South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX
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Hansen KR, DeWalt GJ, Mohammed AI, Tseng HA, Abdulkerim ME, Bensussen S, Saligrama V, Nazer B, Eldred WD, Han X. Mild Blast Injury Produces Acute Changes in Basal Intracellular Calcium Levels and Activity Patterns in Mouse Hippocampal Neurons. J Neurotrauma 2018; 35:1523-1536. [PMID: 29343209 PMCID: PMC5998839 DOI: 10.1089/neu.2017.5029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI) represents a serious public health concern. Although much is understood about long-term changes in cell signaling and anatomical pathologies associated with mTBI, little is known about acute changes in neuronal function. Using large scale Ca2+ imaging in vivo, we characterized the intracellular Ca2+ dynamics in thousands of individual hippocampal neurons using a repetitive mild blast injury model in which blasts were directed onto the cranium of unanesthetized mice on two consecutive days. Immediately following each blast event, neurons exhibited two types of changes in Ca2+ dynamics at different time scales. One was a reduction in slow Ca2+ dynamics that corresponded to shifts in basal intracellular Ca2+ levels at a time scale of minutes, suggesting a disruption of biochemical signaling. The second was a reduction in the rates of fast transient Ca2+ fluctuations at the sub-second time scale, which are known to be closely linked to neural activity. Interestingly, the blast-induced changes in basal Ca2+ levels were independent of the changes in the rates of fast Ca2+ transients, suggesting that blasts had heterogeneous effects on different cell populations. Both types of changes recovered after ∼1 h. Together, our results demonstrate that mTBI induced acute, heterogeneous changes in neuronal function, altering intracellular Ca2+ dynamics across different time scales, which may contribute to the initiation of longer-term pathologies.
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Affiliation(s)
- Kyle R. Hansen
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | | | - Ali I. Mohammed
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Hua-an Tseng
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Moona E. Abdulkerim
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Seth Bensussen
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Venkatesh Saligrama
- Department of Electrical and Computer Engineering, Boston University, Boston, Massachusetts
| | - Bobak Nazer
- Department of Electrical and Computer Engineering, Boston University, Boston, Massachusetts
| | | | - Xue Han
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
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6
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Sandlin DS, Yu Y, Huang J, Zhang C, Arteaga AA, Lippincott JK, Peeden EO, Guyton RR, Chen L, Beneke LL, Allison JC, Zhu H, Zhou W. Autonomic responses to blast overpressure can be elicited by exclusively exposing the ear in rats. J Otol 2018; 13:44-53. [PMID: 30559764 PMCID: PMC6291641 DOI: 10.1016/j.joto.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 11/29/2022] Open
Abstract
Blast overpressure has become an increasing cause of brain injuries in both military and civilian populations. Though blast's direct effects on the cochlea and vestibular organs are active areas of study, little attention has been given to the ear's contribution to the overall spectrum of blast injury. Acute autonomic responses to blast exposure, including bradycardia and hypotension, can cause hypoxia and contribute to blast-induced neurotrauma. Existing literature suggests that these autonomic responses are elicited through blast impacting the thorax and lungs. We hypothesize that the unprotected ear also provides a vulnerable locus for blast to cause autonomic responses. We designed a blast generator that delivers controlled overpressure waves into the ear canal without impacting surrounding tissues in order to study the ear's specific contribution to blast injury. Anesthetized adult rats' left ears were exposed to a single blast wave ranging from 0 to 110 PSI (0-758 kPa). Blast exposed rats exhibited decreased heart rates and blood pressures with increased blast intensity, similar to results gathered using shock tubes and whole-body exposure in the literature. While rats exposed to blasts below 50 PSI (345 kPa) exhibited increased respiratory rate with increased blast intensity, some rats exposed to blasts higher than 50 PSI (345 kPa) stopped breathing immediately and ultimately died. These autonomic responses were significantly reduced in vagally denervated rats, again similar to whole-body exposure literature. These results support the hypothesis that the unprotected ear contributes to the autonomic responses to blast.
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Affiliation(s)
- David S. Sandlin
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, USA
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yue Yu
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jun Huang
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Chunming Zhang
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Otolaryngology, First Affiliated Hospital, Shanxi Medical University, 85 Jiefang S Rd, Yingze Qu, Taiyuan Shi, Shanxi Sheng, China
| | - Alberto A. Arteaga
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - John K. Lippincott
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Erin O.H. Peeden
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ryan R. Guyton
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, USA
| | - Lan Chen
- Summer Undergraduate Research Experience, University of Mississippi Medical Center, Jackson, MS, USA
| | - Laura L.S. Beneke
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jerome C. Allison
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Hong Zhu
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Wu Zhou
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA
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7
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Braun T, Kunz U, Schulz C, Lieber A, Willy C. [Near-infrared spectroscopy for the detection of traumatic intracranial hemorrhage: Feasibility study in a German army field hospital in Afghanistan]. Unfallchirurg 2016; 118:693-700. [PMID: 24435101 DOI: 10.1007/s00113-013-2549-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Traumatic brain injury (TBI) is one of the most common causes of death in ordinary accidents, natural disasters, or warfare. The gold standard for diagnosis of TBI is the CT scan; a delay of diagnostics or medical care is the strongest independent predictor of mortality of TBI patients--particularly in the case of a surgically treatable intracranial hematoma. The proper classification of these patients is of major importance in situations where a CT is not accessible. A portable screening device that uses near-infrared spectroscopy (NIRS) technology allows a preliminary estimate of an intracranial hematoma. This study assessing practicability shows that the use of the device in a military medical rescue center (Kunduz, Afghanistan) is easy to learn and can be repeatedly used even under emergency room conditions. The technique can be applied in penetrating and blunt TBIs in the absence of an immediately available CT scan in rural areas, preclinically, under mass casualty conditions (e.g., in disaster situations) as well as in humanitarian crises or war zones. Nevertheless, further studies to assess the validity of this device are necessary.
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Affiliation(s)
- T Braun
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinkum Giessen, Giessen, Deutschland
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8
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Goodrich GL, Martinsen GL, Flyg HM, Kirby J, Garvert DW, Tyler CW. Visual function, traumatic brain injury, and posttraumatic stress disorder. ACTA ACUST UNITED AC 2014; 51:547-58. [DOI: 10.1682/jrrd.2013.02.0049] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 12/16/2013] [Indexed: 11/05/2022]
Affiliation(s)
| | - Gary L. Martinsen
- Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Heidi M. Flyg
- Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jennine Kirby
- Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Donn W. Garvert
- Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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9
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Kennedy CH, Porter Evans J, Chee S, Moore JL, Barth JT, Stuessi KA. Return to combat duty after concussive blast injury. Arch Clin Neuropsychol 2012; 27:817-27. [PMID: 23059351 DOI: 10.1093/arclin/acs092] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Little data exist regarding the acute assessment of blast concussion and the course of recovery in the combat zone, as most research has examined service members long after they have returned home. This manuscript examined a case series of 377 service members seen for acute concussion evaluation following medical evacuation from the battlefield in Helmand Province, Afghanistan. Of these, 111 were assessed for concussion prior to their return to the continental USA for other severe physical injuries. Of the remainder, and when comparing those who returned to duty (RTD)/recovered from concussion in the combat zone and those who did not, data indicate that those who did not RTD were older and were more likely to endorse symptoms of combat stress. Quicker recovery times were associated with less severe headaches and fewer acute symptoms at the time of injury as well as the absence of combat stress reaction. Variables that were not associated with RTD and/or recovery were Military Acute Concussion Evaluation (MACE) cognitive scores and whether or not individuals suffered loss of consciousness. While MACE scores were not associated with recovery, they were deemed clinically useful as a part of a serial concussion evaluation if the initial MACE was given within 6 h of the blast. Implications for battlefield concussion assessment and management as well as future research directions are discussed.
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Affiliation(s)
- Carrie H Kennedy
- Department of Behavioral Sciences, Marine Corps Embassy Security Group, Quantico, VA 22134, USA.
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10
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Sutiono AB, Suwa H, Ohta T, Arifin MZ, Kitamura Y, Yoshida K, Merdika D, Qiantori A, Iskandar. Development traumatic brain injury computer user interface for disaster area in Indonesia supported by emergency broadband access network. J Med Syst 2012; 36:3955-66. [PMID: 22773106 DOI: 10.1007/s10916-012-9867-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 06/21/2012] [Indexed: 11/24/2022]
Abstract
Disasters bring consequences of negative impacts on the environment and human life. One of the common cause of critical condition is traumatic brain injury (TBI), namely, epidural (EDH) and subdural hematoma (SDH), due to downfall hard things during earthquake. We proposed and analyzed the user response, namely neurosurgeon, general doctor/surgeon and nurse when they interacted with TBI computer interface. The communication systems was supported by TBI web based applications using emergency broadband access network with tethered balloon and simulated in the field trial to evaluate the coverage area. The interface consisted of demography data and multi tabs for anamnesis, treatment, follow up and teleconference interfaces. The interface allows neurosurgeon, surgeon/general doctors and nurses to entry the EDH and SDH patient's data during referring them on the emergency simulation and evaluated based on time needs and their understanding. The average time needed was obtained after simulated by Lenovo T500 notebook using mouse; 8-10 min for neurosurgeons, 12-15 min for surgeons/general doctors and 15-19 min for nurses. By using Think Pad X201 Tablet, the time needed for entry data was 5-7 min for neurosurgeon, 7-10 min for surgeons/general doctors and 12-16 min for nurses. We observed that the time difference was depending on the computer type and user literacy qualification as well as their understanding on traumatic brain injury, particularly for the nurses. In conclusion, there are five data classification for simply TBI GUI, namely, 1) demography, 2) specific anamnesis for EDH and SDH, 3) treatment action and medicine of TBI, 4) follow up data display and 5) teleneurosurgery for streaming video consultation. The type of computer, particularly tablet PC was more convenient and faster for entry data, compare to that computer mouse touched pad. Emergency broadband access network using tethered balloon is possible to be employed to cover the communications systems in disaster area.
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Affiliation(s)
- Agung Budi Sutiono
- Graduate Department Social Intelligence and Informatics, The University Electro Communications, 1-5-1 Chofugaoka, Chofushi, Tokyo 182-8585, Japan.
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11
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Ruff RL, Riechers RG, Wang XF, Piero T, Ruff SS. A case-control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI. BMJ Open 2012; 2:e000312. [PMID: 22431700 PMCID: PMC3312078 DOI: 10.1136/bmjopen-2011-000312] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is a common injury among military personnel serving in Iraq or Afghanistan. The impact of repeated episodes of combat mTBI is unknown. OBJECTIVE To evaluate relationships among mTBI, post-traumatic stress disorder (PTSD) and neurological deficits (NDs) in US veterans who served in Iraq or Afghanistan. METHODS This was a case-control study. From 2091 veterans screened for traumatic brain injury, the authors studied 126 who sustained mTBI with one or more episodes of loss of consciousness (LOC) in combat. Comparison groups: 21 combat veterans who had definite or possible episodes of mTBI without LOC and 21 veterans who sustained mTBI with LOC as civilians. RESULTS Among combat veterans with mTBI, 52% had NDs, 66% had PTSD and 50% had PTSD and an ND. Impaired olfaction was the most common ND, found in 65 veterans. The prevalence of an ND or PTSD correlated with the number of mTBI exposures with LOC. The prevalence of an ND or PTSD was >90% for more than five episodes of LOC. Severity of PTSD and impairment of olfaction increased with number of LOC episodes. The prevalence of an ND for the 34 combat veterans with one episode of LOC (4/34=11.8%) was similar to that of the 21 veterans of similar age and educational background who sustained civilian mTBI with one episode of LOC (2/21=9.5%, p-NS). CONCLUSIONS Impaired olfaction was the most frequently recognised ND. Repeated episodes of combat mTBI were associated with increased likelihood of PTSD and an ND. Combat setting may not increase the likelihood of an ND. Two possible connections between mTBI and PTSD are (1) that circumstances leading to combat mTBI likely involve severe psychological trauma and (2) that altered cerebral functioning following mTBI may increase the likelihood that a traumatic event results in PTSD.
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Affiliation(s)
- Robert Louis Ruff
- Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
- Polytrauma System of Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Ronald George Riechers
- Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
- Polytrauma System of Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Xiao-Feng Wang
- Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Traci Piero
- Polytrauma System of Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Suzanne Smith Ruff
- Polytrauma System of Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Psychology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
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