|
Citation
|
Mac Donald CL, Barber J, Patterson J, Johnson AM, Parsey C, Scott B, Fann JR, Temkin NR. Neurology 2020; ePub(ePub): ePub. |
|
Abstract
|
OBJECTIVE: To compare 1-year and 5-year clinical outcomes in 2 groups of combat-deployed-non-brain-injured service members to 2 groups of combat-related concussion to better understand long-term clinical outcome trajectories.
METHODS: This prospective, observational, longitudinal multi-cohort study examined 4 combat-deployed groups: non-head-injured controls with or without blast exposure, and patients with combat concussion arising from blast or blunt trauma. 1-year and 5-year clinical evaluations included identical batteries for neurobehavioral, psychiatric, and cognitive outcomes. Three hundred forty-seven participants completed both time points of evaluation. Cross-sectional and longitudinal comparisons were assessed. Overall group-effect was modelled as a four-category variable with rank regression adjusting for demographic factors using a two-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 domains of neurobehavioral-NRS (Cohen's-d, -1.10 to -1.40, CIs [-0.82: -1.32] to [-0.97: -1.83] by group), and psychiatric-CAPS (Cohen's-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% neurobehavior-NRS; 41%-54% psychiatric-CAPS by group). Both control groups fared better but a subset also had clinically significant decline (37%-50% neurobehavior-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.
Language: en |