Verfügbarkeit: Gulf war and health

Gulf war and health: 7 Long-term consequences of traumatic brain injury

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Format:	Buch
Sprache:	English
Veröffentlicht:	Washington, D.C. National Academy Press 2009
Online-Zugang:	Inhaltsverzeichnis
Beschreibung:	XIII, 381 S. Ill.
ISBN:	9780309124089

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Datensatz im Suchindex

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adam_text	CONTENTS PREFACE ....................................................................................................................................xiii SUMMARY .....................................................................................................................................1 1 INTRODUCTION ....................................................................................................................13 Background ...............................................................................................................................13 Traumatic Brain Injury ..............................................................................................................14 Operation Enduring Freedom and Operation Iraqi Freedom ....................................................15 Charge to the Committee ..........................................................................................................15 Scope of the Report ...................................................................................................................15 Organization of the Report ........................................................................................................16 References .................................................................................................................................17 2 BIOLOGY OF TRAUMATIC BRAIN INJURY .....................................................................19 Pathobiology of Traumatic Brain Injury ...................................................................................19 Traditional Classifications of Traumatic Brain Injury ..............................................................25 Classification According to Extent of Pathology ......................................................................25 Classification According to Biomechanics of Injury ................................................................27 Therapeutics and Traumatic Brain Injury .................................................................................28 Summary of Pathobiology of Traumatic Brain Injury ..............................................................29 Traumatic Brain Injuries Relevant to the Military ....................................................................30 Basic Mechanisms of Explosive Injuries ..................................................................................31 Severity Scoring of Blast Injuries and Traumatic Brain Injury ................................................41 References .................................................................................................................................46 3 EPIDEMIOLOGY OF ADULT TRAUMATIC BRAIN INJURY ..........................................59 Incidence of Traumatic Brain Injury .........................................................................................61 Brain Injury Severity .................................................................................................................63 Risk Factors for Traumatic Brain Injury ...................................................................................64 Recurrent Traumatic Brain Injury .............................................................................................67 Traumatic Brain Injury and Short-Term Outcomes ..................................................................68 Summary ...................................................................................................................................69 References .................................................................................................................................96 4 CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE .......103 Identification of the Literature ................................................................................................103 Types of Evidence ...................................................................................................................104 Inclusion Criteria .....................................................................................................................110 Considerations in Assessing the Strength of Evidence ...........................................................112 Limitations of Studies .............................................................................................................113 References ...............................................................................................................................115 IX 5 MAJOR COHORT STUDIES ................................................................................................117 General Limitations of Cohort Studies ...................................................................................117 Organization of the Chapter ....................................................................................................118 Military Studies .......................................................................................................................118 Population-Based Studies .......................................................................................................127 Other Cohort Studies ...............................................................................................................133 Studies of Sports-Related Traumatic Brain Injury ..................................................................140 References ...............................................................................................................................166 6 NEUROCOGNITIVE OUTCOMES ......................................................................................173 Penetrating Brain Injury ..........................................................................................................173 Closed Head Injury .................................................................................................................181 References ...............................................................................................................................194 7 NEUROLOGIC OUTCOMES ................................................................................................197 Seizure Disorders ....................................................................................................................197 Postconcussion Symptoms ......................................................................................................210 Ocular and Visual Motor Deterioration ..................................................................................224 Endocrine Disorders ................................................................................................................227 Neurodegenerative Diseases ...................................................................................................237 Dementia of the Alzheimer Type ............................................................................................237 Dementia Pugilistica ...............................................................................................................243 Parkinsonism ...........................................................................................................................246 Multiple Sclerosis ...................................................................................................................251 Amyotrophic Lateral Sclerosis ................................................................................................254 References ...............................................................................................................................256 8 PSYCHIATRIC OUTCOMES ...............................................................................................265 Mood Disorders .......................................................................................................................266 Suicide .....................................................................................................................................276 Anxiety Disorders ...................................................................................................................281 Other Psychiatric Outcomes ....................................................................................................289 Aggressive Behaviors .........................................................................................................289 Drug and Alcohol Abuse Disorders ...................................................................................291 Psychotic Disorders ............................................................................................................292 References ...............................................................................................................................297 9 SOCIAL FUNCTIONING ......................................................................................................301 Primary Studies of Military Populations .................................................................................301 Primary Studies of Civilian Populations .................................................................................303 Secondary Studies ...................................................................................................................307 Summary and Conclusions ......................................................................................................314 References ...............................................................................................................................328 10 OTHER HEALTH OUTCOMES ...........................................................................................333 Mortality and Traumatic Brain Injury .....................................................................................333 Primary Studies .......................................................................................................................333 Secondary Studies ...................................................................................................................336 Summary and Conclusions ......................................................................................................339 Brain Tumors and Traumatic Brain Injury .............................................................................350 Primary Studies .......................................................................................................................350 Secondary Studies ...................................................................................................................354 Summary and Conclusions ......................................................................................................355 References ...............................................................................................................................364 11 CONCLUSIONS AND RECOMMENDATIONS .................................................................367 Quality of the Studies ..............................................................................................................367 Overview of Health Outcomes ................................................................................................368 Recommendations ...................................................................................................................370 INDEX .........................................................................................................................................373 TABLES AND FIGURES TABLE 2.1 Safety Recommendations for Standoff Distances from Different Types of Exploding Bombs ....................................................................................31 TABLE 2.2 Overpressure Effects on Surrounding Materials and Unprotected Persons ...............33 TABLE 2.3 Summary of Most Important Body-System Injuries Induced by Concomitant Primary, Secondary, Tertiary, and Quaternary Effects of Blast ............................................34 TABLE 3.1 Glasgow Coma Scales and Glasgow Outcome Scales ...............................................70 TABLE 3.2 US TBI Incidence Studies: Case Identification, Data Source, and TBI Severity Scoring ...................................................................................................................................71 TABLE 3.3 Non-US Incidence Studies: Case Identification, Data Source, and TBI Severity Score ..........................................................................................................75 TABLE 3.4 US TBI Incidence Studies ..........................................................................................79 TABLE 3.5 Non-US TBI Incidence Data ......................................................................................81 TABLE 3.6 US TBI Deaths and Mortality Rates ..........................................................................84 TABLE 3.7 Non-US TBI Deaths and Mortality Rates ..................................................................85 TABLE 3.8 Percent Severity Distributions of Hospitalized Patients in US and Non-US Incidence Studies ....................................................................................87 TABLE 3.9 Highest Age-Specific TBI Rates and Gender Rate Ratios: US Studies .....................89 TABLE 3.10 Highest Age-Specific TBI Rates and Gender Rate Ratios: Non-US Studies ..........90 TABLE 3.11 Percent Distributions of TBI Incidence Cases by External Cause: US Studies .......91 TABLE 3.12 Percent Distributions of TBI Incidence Cases by External Cause: Non-US Studies .....................................................................................................................92 TABLE 3.13 TBI In-Hospital Case Fatality Rates (CFR) from US Population-Based Studies....93 TABLE 3.14 TBI In-Hospital Case Fatality Rates (CFR) from Non-US Population-Based Studies ......................................................................................................94 TABLE 3.15 Percent Distribution of GOS Outcome Categories at Hospital Discharge Rate for US and Non-US Studies ...........................................................................................95 TABLE 5.1 Major Cohort Studies (Shaded) and Derivative Studies ..........................................143 TABLE 6.1 Penetrating Head Injury and Neurocognitive Outcomes .........................................178 TABLE 6.2 Closed Head Injury and Neurocognitive Outcomes ................................................189 TABLE 7.1 Seizure Disorders and TBI .......................................................................................204 xi TABLE 7.2 Symptoms After Deployment According to Type of Injury During Deployment ..........................................................................................................................211 TABLE 7.3 Frequency of Symptoms on RPCS Questionnaire ...................................................214 TABLE 7.4 Prevalence of Subjective Complaints 5 Years After Injury .....................................216 TABLE 7.5 Postconcussive Symptoms and TBI .........................................................................219 TABLE 7.6 Ocular and Visual Motor Deterioration and TBI .....................................................226 TABLE 7.7 Endocrine Disorders and TBI ..................................................................................233 TABLE 7.8 Dementia of the Alzheimer Type and TBI ...............................................................242 TABLE 7.9 Parkinsonism and TBI ..............................................................................................249 TABLE 7.10 Multiple Sclerosis and TBI ....................................................................................253 TABLE 8.1 Psychologic Outcomes—Mood-Disorder Studies ...................................................270 TABLE 8.2 Psychologic Outcomes—TBI and Suicide ...............................................................279 TABLE 8.3 Psychologic Outcomes — Anxiety Disorder Studies ................................................285 TABLE 8.4 Psychologic Outcomes — Personality Disorder Studies ...........................................294 TABLE 9.1 Social Function ........................................................................................................316 TABLE 10.1 TBI and Mortality ..................................................................................................340 TABLE 10.2 TBI and Brain Tumors ...........................................................................................356 FIGURE 2.1 Pathologic classification of TBI ...............................................................................26 FIGURE 2.2 Classification of TBI based on primary insult ..........................................................28 FIGURE 2.3 Potential consequences of blast exposure .................................................................30 FIGURE 2.4 Explosion-induced shock waves ...............................................................................32 FIGURE 2.5 Examination and diagnosis algorithm for blast injuries ...........................................36 FIGURE 2.6 Complex mechanisms of blast-induced neurotrauma ...............................................37 FIGURE 2.7 Brief Traumatic Brain Injury Screen ........................................................................45 хи
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