Excerpt

Traumatic brain injury (TBI) is a common condition, especially among military members. Twelve to 23 percent of service members returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) experienced a TBI while deployed. Although various criteria are used to define TBI severity, the majority of documented TBI events among OEF/OIF/OND service members may be classified as mild in severity, or mTBI, according to the definition used by the Veterans Health Administration and Department of Defense (VA/DoD).

While some researchers suggest most individuals recover within three months of an mTBI, others estimate that 10 to 20 percent of individuals continue to experience post-concussive symptoms (e.g., headaches, dizziness, balance problems) beyond this time fame. This estimate may be higher among OEF/OIF service members given the frequency of multiple TBI events, concomitant mental health conditions such as depression and posttraumatic stress disorder (PTSD), and other factors unique to combat deployments. As such, deployment-related mTBI is a significant issue for the VA, as patients who report ongoing mTBI symptoms may require the attention from a range of health care professionals. This evidence synthesis review will be used by the VHA TBI Advisory Committee to develop strategies to identify those at-risk for long-term mTBI effects, inform clinical practice, determine resource allocation, and identify future research priorities.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • RESULTS
  • LIMITATIONS AND FUTURE RESEARCH
  • ABBREVIATIONS TABLE
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • METHODOLOGIC CONSIDERATIONS
  • LITERATURE FLOW
  • SUMMARY OF FINDINGS
  • COGNITIVE FUNCTIONING RESULTS
  • PHYSICAL HEALTH RESULTS
  • MENTAL HEALTH RESULTS
  • FUNCTIONAL/SOCIAL OUTCOME RESULTS
  • SERVICE UTILIZATION/COSTS RESULTS
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE
  • LIMITATIONS AND RECOMMENDATIONS FOR FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGIES
• APPENDIX B STUDY SELECTION FORM
• APPENDIX C DEFINITION OF MTBI FROM THE VA/DOD CLINICAL PRACTICE GUIDELINE FOR MANAGEMENT OF CONCUSSION/MILD TRAUMATIC BRAIN INJURY (2009)
• APPENDIX D EXCLUDED STUDIES THAT DID NOT MEET MTBI DEFINITION CRITERIA
• APPENDIX E RESULTS OF INCLUDED STUDIES
• APPENDIX F LIST OF EXCLUDED STUDIES GROUPED BY REASON FOR EXCLUSION
• APPENDIX G PEER REVIEW COMMENTS AND RESPONSES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Portland VA Medical Center, Portland, OR, Devan Kansagara, M.D., M.C.R., Director

Suggested citation:

O'Neil ME, Carlson KF, Storzbach D, Brenner LA, Freeman M, Quiñones A, Motu’apuaka M, Ensley M, Kansagara D. Complications of Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review. VA-ESP Project #05-225; 2012

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Portland VA Medical Center, Portland, OR funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.