Gulf War and Health Volume 7: Long-Term Consequences of Traumatic Brain Injury (2009) / Chapter Skim
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SUMMARY
SUMMARY
Pages 1-12
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From page 1... ...
In 1998, in response to the growing concerns of ill Gulf War veterans, Congress passed two laws: PL 105-277, the Persian Gulf War Veterans Act, and PL 105-368, the Veterans Programs Enhancement Act. Those laws directed the secretary of veterans affairs to enter into a contract with the National Academy of Sciences (NAS)
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From page 2... ...
According to the World Health Organization Collaborating Task Force on Mild Traumatic Brain Injury, mild TBI might also be referred to as a concussion, a minor brain injury, a mild head injury, or a minor head injury. Furthermore, it has been noted that the term concussion, often used to indicate a mild or moderate brain injury, refers to a disturbance in neurologic function caused by the mechanical force of rapid acceleration or deceleration, and can include varied symptoms and severity.
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From page 3... ...
Furthermore, there is an outdated dogma that neurologic impairments caused by primary blasts are rare because the skull provides excellent protection for the brain, that is, that brain injury is a consequence solely of air emboli in cerebral blood vessels. Despite recent clinical findings, experimental findings, and experience in contemporary military operations that suggest that substantial short-term and long-term neurologic deficits can be caused by blast exposure without a direct blow to the head, the old belief prevails in the professional literature and in civilian clinical practice.
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From page 4... ...
LIMITATIONS OF THE STUDIES OF TRAUMATIC BRAIN INJURY Many of the studies reviewed by the committee presented substantial obstacles to determining associations between TBI and long-term health outcomes in that they were beset by limitations that are commonly encountered in epidemiologic studies, including lack of a representative sample, selection bias, lack of control for potential confounding factors, selfreporting of exposure and health outcomes, premorbid status, and outcome misclassification. Some of the studies reviewed did not specify the time between injury and followup, so the committee could not determine whether the outcome lasted longer than 6 months.
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From page 5... ...
For example, with regard to neurocognitive outcomes, the committee found sufficient evidence of an association between penetrating TBI and decline in neurocognitive function associated with the
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From page 6... ...
With regard to closed head injuries, the committee found sufficient evidence of an association between severe TBI and neurocognitive deficits, limited but suggestive evidence of an association between moderate TBI and neurocognitive deficits, and inadequate and insufficient evidence of an association between mild TBI and neurocognitive deficits. With regard to neurologic effects, the studies reviewed had numerous findings, including a strong association between brain injury and unprovoked seizures.
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From page 7... ...
With regard to mild TBI, however, the committee concluded that the evidence was inadequate and insufficient with respect to long-term adverse social functioning, including unemployment, diminished social relationships, and decrease in the ability to live independently. There is sufficient evidence of a causal relationship between injury and premature death in people who survive penetrating head injury.
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From page 8... ...
Nevertheless, use of additional TBI scoring systems is recommended, especially in the case of mild TBI or suspected concussion or when medical records provide less detailed information about the injury and its circumstances. In the military environment, use of the Brief Traumatic Brain Injury Screen and the Military Acute Concussion Evaluation is recommended for every soldier who has a history of blast exposure (even lowintensity blast exposure)
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From page 9... ...
The committee recommends that the Department of Veterans Affairs include, in the development of the Traumatic Brain Injury Veterans Health Registry (hereafter referred to as "the registry") , other service members who could provide a valid comparison for the analysis of outcomes.
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From page 10... ...
Severe or moderate TBI and unprovoked seizures. Sufficient Evidence of an Association Evidence is sufficient to conclude that there is a positive association; that is, a consistent association has been observed between TBI and a specific health outcome in human studies in
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From page 11... ...
Moderate to severe TBI and long-term adverse social-function outcomes, particularly unemployment and diminished social relationships. Moderate or severe TBI, in the subset of patients who are either admitted into or discharged from rehabilitation centers or receive disability support, and premature death.
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From page 12... ...
TBI and amyotrophic lateral sclerosis. Limited/Suggestive Evidence of No Association Evidence from several adequate studies, covering the full range of severity of TBI that humans are known to encounter, is consistent in not showing a positive association between TBI and a specific health outcome.
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