Jan Elizabeth Kennedy, Joseph Booth Warren, Lisa Hsiao-Jung Lu, Cristina Yvette Lawrence, Matthew Wade Reid
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Possible reasons suggested for the earlier findings include SMs with bodily injuries report fewer postconcussive symptoms due to (1) focusing attention on extra-cranial injuries and associated pain; (2) receiving more interpersonal and medical support, lowering distress; (3) using analgesics such as morphine or opioids; or (4) experiencing delayed postconcussive symptoms. The current investigation evaluates each of these hypothesized reasons for the earlier findings and the generalizability of the findings to a more recent sample. Data were extracted from 165 SMs in a TBI repository at a U.S. military medical center. All participants reported a history of an mTBI, confirmed by a clinical interview to meet Veterans Affairs and Department of Defense criteria. Other bodily injuries received at the time of the mTBI were documented with the Abbreviated Injury Scale (AIS). Multiple regression models evaluated the ability of the four hypothesized mechanisms to predict postconcussive symptom severity, measured by the Neurobehavioral Symptom Inventory. SMs with bodily injuries (<i>n</i> = 48) reported nonsignificantly lower postconcussive symptoms than SMs with no bodily injuries (<i>n</i> = 117). The level of subjective pain was a determinant of postconcussive symptom severity among SMs with a history of mTBI, with or without associated bodily injuries. 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引用次数: 0
摘要
研究发现,轻度脑损伤(mTBI)并发身体损伤的军人(SMs)与轻度脑损伤并发身体损伤的军人(SMs)相比,其撞击后慢性症状的严重程度较低。研究主要针对 9/11 战争后受爆炸伤的 SM 进行。目前的研究则是在一个更具异质性且近期接受过评估的军方 SM 人群中探讨这些发现。早期研究结果的可能原因包括:身体受伤的 SM 报告的撞击后症状较少,原因是:(1)将注意力集中在颅外损伤和相关疼痛上;(2)获得更多的人际和医疗支持,减少了痛苦;(3)使用吗啡或阿片类药物等镇痛剂;或(4)经历了延迟的撞击后症状。目前的调查评估了早先研究结果的每一个假设原因,以及这些研究结果对更近期样本的可推广性。我们从美国一家军事医疗中心的创伤性脑损伤资料库中提取了 165 名 SM 的数据。所有参与者都报告了 mTBI 病史,并经临床访谈确认符合退伍军人事务部和国防部的标准。发生 mTBI 时受到的其他身体伤害用简易伤害量表 (AIS) 进行了记录。多元回归模型评估了四种假设机制预测撞击后症状严重程度的能力,这些症状由神经行为症状量表(Neurobehavioral Symptom Inventory)测量。身体受伤的 SM(48 人)报告的撞击后症状明显低于身体未受伤的 SM(117 人)。无论是否伴有身体损伤,主观疼痛程度都是有mTBI病史的SM休克后症状严重程度的决定因素。在没有相关身体损伤的 SM 中,社会支持对其撞击后症状的负面预测作用较弱。
Symptomatic Recovery from Concussion in Military Service Members with and Without Associated Bodily Injuries.
Research has found that service members (SMs) with mild traumatic brain injury (mTBI) and co-occurring bodily injuries endorse lower chronic postconcussive symptom severity than SMs with mTBI and no bodily injuries. Investigations were conducted with primarily post-9/11 war-era SMs with blast injuries. The current study explores these findings in a cohort of more heterogeneous and recently evaluated military SM. Possible reasons suggested for the earlier findings include SMs with bodily injuries report fewer postconcussive symptoms due to (1) focusing attention on extra-cranial injuries and associated pain; (2) receiving more interpersonal and medical support, lowering distress; (3) using analgesics such as morphine or opioids; or (4) experiencing delayed postconcussive symptoms. The current investigation evaluates each of these hypothesized reasons for the earlier findings and the generalizability of the findings to a more recent sample. Data were extracted from 165 SMs in a TBI repository at a U.S. military medical center. All participants reported a history of an mTBI, confirmed by a clinical interview to meet Veterans Affairs and Department of Defense criteria. Other bodily injuries received at the time of the mTBI were documented with the Abbreviated Injury Scale (AIS). Multiple regression models evaluated the ability of the four hypothesized mechanisms to predict postconcussive symptom severity, measured by the Neurobehavioral Symptom Inventory. SMs with bodily injuries (n = 48) reported nonsignificantly lower postconcussive symptoms than SMs with no bodily injuries (n = 117). The level of subjective pain was a determinant of postconcussive symptom severity among SMs with a history of mTBI, with or without associated bodily injuries. Social support was a weaker negative predictor of postconcussive symptoms among SMs with no associated bodily injuries.