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Combat-related blast injuries : injury types and outcomes


Combat-related blasts have caused the majority of injuries in Operation Iraqi Freedom with traumatic brain injury (TBI) emerging as a preeminent injury. The purpose of this dissertation is to describe the scope of combat-related blast injuries and the career performance outcomes of service personnel injured in blasts. Factors associated with career performance outcomes in service personnel injured in blasts and specifically in those with mild TBI were also explored. The Combat Trauma Registry Expeditionary Medical Encounter Database (CTR-EMED) is a collection of datasets from frontline medical care in Iraq and subsequent hospital care. The CTR-EMED provided demographics of injured service personnel and injury episode information. Outcome variables were ascertained from the Career History Archival Medical and Personnel System, which is a database of career and medical information for service personnel. In the 4623 blast episodes examined, mild TBI was the most frequent single injury type (10.8%) and with extremity injuries combined, the extremities was the area most commonly injured. Surface wounds of the extremities comprised 27.6% of all injuries. When examining service discharge in 4255 personnel injured in combat-related blasts, 37.8% experienced normal attrition and 8.3% early attrition. In service personnel with a discharge code, 29.8% had a disability-related discharge. Both early attrition and disability discharge proportions were higher in those with PTSD. In those without PTSD, a dose response relationship existed between injury severity and both disability discharge and early attrition. In those with a PTSD diagnosis, injury severity was associated with these adverse outcomes but the relationship was more complex. In the 790 service personnel diagnosed with mild TBI after a combat-related blast, 24% experienced a disability discharge. The most common acute TBI symptoms documented were headache (63.0%), loss of consciousness (37.0%) and tinnitus (31.0%). In those without PTSD, disability discharge was associated with age, total injury severity, time to discharge and post-concussive syndrome, while disability discharge was only associated with post- concussive syndrome in those with PTSD. These results provide important information for acute and rehabilitative care providers. The impact of PTSD on recovery after combat-related blast injuries should be explored to maximize functional outcome in these service personnel

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