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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...

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Autores principales: Mac Donald, Christine L., Barber, Jason, Patterson, Jana, Johnson, Ann M., Parsey, Carolyn, Scott, Beverly, Fann, Jesse R., Temkin, Nancy R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
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.
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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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