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Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion
OBJECTIVE: To compare 1-year and 5-year clinical outcomes in 2 groups of combat-deployed service members without brain injury to those of 2 groups with combat-related concussion to better understand long-term clinical outcome trajectories. METHODS: This prospective, observational, longitudinal multi...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884983/ https://www.ncbi.nlm.nih.gov/pubmed/33177226 http://dx.doi.org/10.1212/WNL.0000000000011089 |
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author | Mac Donald, Christine L. Barber, Jason Patterson, Jana Johnson, Ann M. Parsey, Carolyn Scott, Beverly Fann, Jesse R. Temkin, Nancy R. |
author_facet | Mac Donald, Christine L. Barber, Jason Patterson, Jana Johnson, Ann M. Parsey, Carolyn Scott, Beverly Fann, Jesse R. Temkin, Nancy R. |
author_sort | Mac Donald, Christine L. |
collection | PubMed |
description | OBJECTIVE: To compare 1-year and 5-year clinical outcomes in 2 groups of combat-deployed service members without brain injury to those of 2 groups with combat-related concussion to better understand long-term clinical outcome trajectories. METHODS: This prospective, observational, longitudinal multicohort study examined 4 combat-deployed groups: controls without head injury with or without blast exposure and patients with combat concussion arising from blast or blunt trauma. One-year and 5-year clinical evaluations included identical batteries for neurobehavioral, psychiatric, and cognitive outcomes. A total of 347 participants completed both time points of evaluation. Cross-sectional and longitudinal comparisons were assessed. Overall group effect was modeled as a 4-category variable with rank regression adjusting for demographic factors using a 2-sided significance threshold of 0.05, with post hoc Tukey p values calculated for the pairwise comparisons. RESULTS: Significant group differences in both combat concussion groups were identified cross-sectionally at 5-year follow-up compared to controls in neurobehavioral (Neurobehavioral Rating Scale–Revised [NRS]; Cohen d, −1.10 to −1.40, confidence intervals [CIs] [−0.82, −1.32] to [−0.97, −1.83] by group) and psychiatric domains (Clinician-Administered PTSD Scale for DSM-IV [CAPS]; Cohen d, −0.91 to −1.19, CIs [−0.63, −1.19] to [−0.76, −1.62] by group) symptoms with minimal differences in cognitive performance. Both combat concussion groups also showed clinically significant decline from 1- to 5-year evaluation (66%–76% neurobehavioral NRS; 41%–54% psychiatric CAPS by group). Both control groups fared better but a subset also had clinically significant decline (37%–50% neurobehavioral NRS; 9%–25% psychiatric CAPS by group). CONCLUSIONS: There was an evolution, not resolution, of symptoms from 1- to 5-year evaluation, challenging the assumption that chronic stages of concussive injury are relatively stable. Even some of the combat-deployed controls worsened. The evidence supports new considerations for chronic trajectories of concussion outcome in combat-deployed service members. |
format | Online Article Text |
id | pubmed-7884983 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-78849832021-03-24 Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion Mac Donald, Christine L. Barber, Jason Patterson, Jana Johnson, Ann M. Parsey, Carolyn Scott, Beverly Fann, Jesse R. Temkin, Nancy R. Neurology Article OBJECTIVE: To compare 1-year and 5-year clinical outcomes in 2 groups of combat-deployed service members without brain injury to those of 2 groups with combat-related concussion to better understand long-term clinical outcome trajectories. METHODS: This prospective, observational, longitudinal multicohort study examined 4 combat-deployed groups: controls without head injury with or without blast exposure and patients with combat concussion arising from blast or blunt trauma. One-year and 5-year clinical evaluations included identical batteries for neurobehavioral, psychiatric, and cognitive outcomes. A total of 347 participants completed both time points of evaluation. Cross-sectional and longitudinal comparisons were assessed. Overall group effect was modeled as a 4-category variable with rank regression adjusting for demographic factors using a 2-sided significance threshold of 0.05, with post hoc Tukey p values calculated for the pairwise comparisons. RESULTS: Significant group differences in both combat concussion groups were identified cross-sectionally at 5-year follow-up compared to controls in neurobehavioral (Neurobehavioral Rating Scale–Revised [NRS]; Cohen d, −1.10 to −1.40, confidence intervals [CIs] [−0.82, −1.32] to [−0.97, −1.83] by group) and psychiatric domains (Clinician-Administered PTSD Scale for DSM-IV [CAPS]; Cohen d, −0.91 to −1.19, CIs [−0.63, −1.19] to [−0.76, −1.62] by group) symptoms with minimal differences in cognitive performance. Both combat concussion groups also showed clinically significant decline from 1- to 5-year evaluation (66%–76% neurobehavioral NRS; 41%–54% psychiatric CAPS by group). Both control groups fared better but a subset also had clinically significant decline (37%–50% neurobehavioral NRS; 9%–25% psychiatric CAPS by group). CONCLUSIONS: There was an evolution, not resolution, of symptoms from 1- to 5-year evaluation, challenging the assumption that chronic stages of concussive injury are relatively stable. Even some of the combat-deployed controls worsened. The evidence supports new considerations for chronic trajectories of concussion outcome in combat-deployed service members. Lippincott Williams & Wilkins 2021-01-19 /pmc/articles/PMC7884983/ /pubmed/33177226 http://dx.doi.org/10.1212/WNL.0000000000011089 Text en Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Article Mac Donald, Christine L. Barber, Jason Patterson, Jana Johnson, Ann M. Parsey, Carolyn Scott, Beverly Fann, Jesse R. Temkin, Nancy R. Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion |
title | Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion |
title_full | Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion |
title_fullStr | Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion |
title_full_unstemmed | Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion |
title_short | Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion |
title_sort | comparison of clinical outcomes 1 and 5 years post-injury following combat concussion |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884983/ https://www.ncbi.nlm.nih.gov/pubmed/33177226 http://dx.doi.org/10.1212/WNL.0000000000011089 |
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