Repeated Concussion among U.S. Military Personnel during Operation Iraqi Freedom

By MacGregor, Andrew J.; Dougherty, Amber L. et al. | Journal of Rehabilitation Research & Development, October 2011 | Go to article overview

Repeated Concussion among U.S. Military Personnel during Operation Iraqi Freedom


MacGregor, Andrew J., Dougherty, Amber L., Morrison, Rosemary H., Quinn, Kimberly H., Galarneau, Michael R., Journal of Rehabilitation Research & Development


INTRODUCTION

Traumatic brain injury (TBI) is one of the predominant injuries of the current military conflicts in Iraq and Afghanistan, with prevalence ranging from 15 to 20 percent depending on the diagnostic criteria and patient population [1-7]. A majority of these injuries, 85 percent in one study, are mild concussions resulting from exposure to blasts [1-4,7]. Because military personnel with mild injuries are often returned to full duty status shortly after the injury-causing event, understanding the lasting effects on cognitive and physical functions, as well as the risks associated with repeat injury, is of significant importance [8].

Although research describing the effects of repeated concussions in military populations is limited, civilian literature points to several detrimental physical, cognitive, and emotional health effects of incurring multiple concussions [9-13]. Evidence exists that some aspects of neurocognitive function do not recover as quickly in those who have experienced multiple concussions, and some studies suggest a permanent reduction in cognitive performance [14-15]. One recent study showed greater reduction in neurological activity among persons with two concussions, with reduced time between concussive events acting as an important mediator [16].

The aims of the present study were to (1) provide a descriptive analysis of repeated concussion in U.S. military personnel, (2) identify whether decreased time between events is associated with increased severity of the second event, and (3) identify predictors of postinjury utilization of mental health and neurology outpatient services following the second concussive event.

METHODS

Study Design

The present study was an analysis of servicemembers with repeated concussions that were reported in the Expeditionary Medical Encounter Database (EMED) (formerly the Navy-Marine Corps Combat Trauma Registry). The EMED is a deployment health database maintained by Naval Health Research Center (NHRC), San Diego, California, and consists of documented clinical encounters of deployed military personnel from all service branches (a more extensive description of the EMED can be found elsewhere [17]).

Data Sources

Clinical EMED records were completed by medical providers stationed at forward-deployed Navy-Marine Corps military treatment facilities that were located in Iraq to treat Operation Iraqi Freedom casualties. Unique aspects of the EMED include detailed information regarding the injury incident, which is collected at or near the point of occurrence, as well as the inclusion of persons with otherwise mild injuries who are subsequently returned to duty. Clinical records are provided to NHRC, and professional coders review the records and assign codes using the Abbreviated Injury Scale (AIS); Injury Severity Score (ISS); and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9CM) [18-20].

Study Sample

For the present study, eligible personnel were servicemembers who sustained two or more provider-diagnosed concussions during Operation Iraqi Freedom from March 2004 to April 2008. A concussion was defined by the presence of an ICD-9-CM code of 850.0 to 850.9. Severity of concussion was defined using the AIS, which is a scoring system that details the severity of each injury and is categorized into nine different body regions (i.e., head, neck, face, torso, abdomen, spine, upper limb, lower limb, and external) [18]. All personnel in the study sustained concussions corresponding to a maximum head AIS of 1 (minor injury) or 2 (moderate injury). At the time of the present study, 113 of 14,653 individuals in the EMED with combat or noncombat injury met the inclusion criteria and comprised the study sample. Overall injury severity for each servicemember was determined with the ISS, which is derived from the AIS and ranges from 0 to 75 [19]. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Repeated Concussion among U.S. Military Personnel during Operation Iraqi Freedom
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.