Of 2525 soldiers, 124 (4.9%) reported injuries with loss of consciousness, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting loss of consciousness, 43.9% met criteria for post-traumatic stress disorder (PTSD), as compared with 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who had loss of consciousness, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and postconcussive symptoms than were soldiers with other injuries. However, after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache. Conclusions Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.

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Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq

Measuring Health: A Guide to Rating Scales and Questionnaires

The 2017 Concussion in Sport Group (CISG) consensus statement is designed to build on the principles outlined in the previous statements1–4 and to develop further conceptual understanding of sport-related concussion (SRC) using an expert consensus-based approach. This document is developed for physicians and healthcare providers who are involved in athlete care, whether at a recreational, elite or professional level. While agreement exists on the principal messages conveyed by this document, the authors acknowledge that the science of SRC is evolving and therefore individual management and return-to-play decisions remain in the realm of clinical judgement.

This consensus document reflects the current state of knowledge and will need to be modified as new knowledge develops. It provides an overview of issues that may be of importance to healthcare providers involved in the management of SRC. This paper should be read in conjunction with the systematic reviews and methodology paper that accompany it. First and foremost, this document is intended to guide clinical practice; however, the authors feel that it can also help form the agenda for future research relevant to SRC by identifying knowledge gaps.

A series of specific clinical questions were developed as part of the consensus process for the Berlin 2016 meeting. Each consensus question was the subject of a specific formal systematic review, which is published concurrently with this summary statement. Readers are directed to these background papers in conjunction with this summary statement as they provide the context for the issues and include the scope of published research, search strategy and citations reviewed for each question. This 2017 consensus statement also summarises each topic and recommendations in the context of all five CISG meetings (that is, 2001, 2004, 2008, 2012 as well as 2016). Approximately 60 000 published articles were screened by the expert panels for the Berlin …

https://bjsm.bmj.com/content/bjsports/51/11/838.full.pdf

Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016

Consensus statement on Concussion in Sport - The 4th International Conference on Concussion in Sport held in Zurich, November 2012

The new 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document under the Background section. This document is developed primarily for use by physicians and healthcare professionals who are involved in the care of injured athletes, whether at the recreational, elite or professional level.

/pdf/consensus-statement-on-concussion-in-sport-1b9nytxe0j.pdf

Consensus statement on concussion in sport

Primary objective: To determine the incidence and epidemiology of emergency department (ED)-attended mild traumatic brain injury (mTBI) in the US.Research design: Secondary analysis of ED visits for mTBI in the National Hospital Ambulatory Medical Care Survey for 1998–2000.Methods and procedures: MTBI defined by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for ‘skull fracture’, ‘concussion’, ‘intracranial injury of unspecified nature’ and ‘head injury, unspecified’.Main outcome and results: The average incidence of mTBI was 503.1/100 000, with peaks among males (590/100 000), American Indians/Alaska Natives (1,026/100 000) and those <5 years of age (1,115.2/100 000). MTBI incidence was highest in the Midwest region (578.4/10 000) and in non-urban areas (530.9/100 000) of the US. Bicycles and sports accounted for 26.4% of mTBI in the 5–14 age group.Conclusions: The national burden of mTBI is significant and the incidence higher than that reported by others....

/pdf/mild-traumatic-brain-injury-in-the-united-states-1998-2000-p5zikz08r0.pdf

Mild traumatic brain injury in the United States, 1998-2000

The goal of the current investigation was to detect clinically important axonal damage in cerebral white matter after mild traumatic brain injury (TBI) using diffusion tensor imaging (DTI). To this end, we evaluated a prospective, pilot study of six subjects with isolated mild TBI and six matched orthopedic controls. All subjects underwent DTI scanning, post-concussive symptom (PCS) assessment, and neurobehavioral testing within 72 h of injury. Fractional anisotropy (FA) and trace values in white matter voxels of whole brain and five preslected regions of interest (ROI) were compared in mild TBI and control subjects using a quantile approach. In addition, whole brain images were analyzed using voxel-based morphometry. All subjects underwent quality of life and repeat PCS assessment at 1 month. Whole brain images revealed significantly lower 1st percentile trace values (mean 0.465 vs. 0.488, p = 0.049) among mild TBI subjects. These trace values correlated with PCS scores at both 72 h (r = −0.57, p = 0.05)...

Diffusion tensor imaging detects clinically important axonal damage after mild traumatic brain injury: a pilot study.

Objective To determine the acute predictors associated with the development of postconcussion syndrome (PCS) in children and adolescents after mild traumatic brain injury Design Retrospective analysis of a prospective observational study Setting Pediatric emergency department (ED) in a children's hospital Participants Four hundred six children and adolescents aged 5 to 18 years Main Exposure Closed head trauma Main Outcome Measures The Rivermead Post Concussion Symptoms Questionnaire administered 3 months after the injury Results Of the patients presenting to the ED with mild traumatic brain injury, 293% developed PCS The most frequent PCS symptom was headache Predictors of PCS, while controlling for other factors, were being of adolescent age, headache on presentation to the ED, and admission to the hospital Patients who developed PCS missed a mean (SD) of 74 (139) days of school Conclusions Adolescents who have headache on ED presentation and require hospital admission at the ED encounter are at elevated risk for PCS after mild traumatic brain injury Interventions to identify this population and begin early treatment may improve outcomes and reduce the burden of disease

https://jamanetwork.com/journals/jamapediatrics/articlepdf/1486427/poa120065_156_161.pdf

Predicting Postconcussion Syndrome After Mild Traumatic Brain Injury in Children and Adolescents Who Present to the Emergency Department

The objective of this study was to estimate the independent association of sex with outcome after mild traumatic brain injury (mTBI). We performed an analysis of a subset of an established cohort involving 1425 mTBI patients presenting to an academic emergency department (ED). The associations between sex and three outcomes determined 3 months after the initial ED visit were examined: post-concussive symptom (PCS) score (0, 1–5, 6–16, and >16), the number of days to return of normal activities (0, 1–7, and >7), and the number of days of work missed (0, 1–7,and >7). Logistic regression analyses were used to determine the relationship between sex and each outcome after controlling for 12 relevant subject-level variables. Of the 1425 subjects, 643 (45.1%) were female and 782 (54.9%) were male. Three months after mTBI, males had significantly lower odds of being in a higher PCS score category (odds ratio [OR] 0.62, 95% confidence interval [CI]: 0.50, 0.78); this association appeared to be more promin...

/pdf/sex-differences-in-outcome-after-mild-traumatic-brain-injury-48p3njwu57.pdf

Sex Differences in Outcome after Mild Traumatic Brain Injury

Objective : To determine if clinical variables or neurobehavioural test (NBT) scores obtained in the ED within 24 hours of minor head injury (MHI) predict the development of postconcussive syndrome (PCS). Methods : Prospective, observational study of 71 MHI patients and 60 orthopaedic controls. MHI defined as loss of consciousness < 10 minutes or amnesia, GCS 15, no skull fracture or new neurologic focality on PE, and no brain injury on CT (if done). All patients received a seven part NBT battery in the ED. Telephone follow-up was done at 1, 3 and 6 months to determine if patients met the DSM IV definition of PCS. Analysis : Stepwise, multivariate, logistic regression. Results : Predictors of PCS at 1 month were female gender (OR 7.8; 95% CI 41.6, 1.98), presence of both retrograde and anterograde amnesia (OR 0.055; CI 0.002, 0.47), Digit Span Forward Scores (OR 0.748; CI 0.52, 1.03) and Hopkins Verbal Learning A scores (OR 0.786; CI 0.65, 0.91); at 3 months, presence of both retrograde and anterograde...

Jeffrey J. Bazarian

Papers

Mild traumatic brain injury in the United States, 1998-2000

Diffusion tensor imaging detects clinically important axonal damage after mild traumatic brain injury: a pilot study.

Predicting Postconcussion Syndrome After Mild Traumatic Brain Injury in Children and Adolescents Who Present to the Emergency Department

Sex Differences in Outcome after Mild Traumatic Brain Injury

Epidemiology and predictors of post-concussive syndrome after minor head injury in an emergency population