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Neurology
Research
A case–control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI
  1. Robert Louis Ruff1,2,3,
  2. Ronald George Riechers II1,2,3,
  3. Xiao-Feng Wang4,
  4. Traci Piero3,
  5. Suzanne Smith Ruff3,5
  1. 1Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
  2. 2Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
  3. 3Polytrauma System of Care, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
  4. 4Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, Ohio, USA
  5. 5Psychology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
  1. Correspondence to Dr Robert Louis Ruff; robert.ruff1{at}va.gov

Abstract

Background Mild traumatic brain injury (mTBI) is a common injury among military personnel serving in Iraq or Afghanistan. The impact of repeated episodes of combat mTBI is unknown.

Objective To evaluate relationships among mTBI, post-traumatic stress disorder (PTSD) and neurological deficits (NDs) in US veterans who served in Iraq or Afghanistan.

Methods This was a case–control study. From 2091 veterans screened for traumatic brain injury, the authors studied 126 who sustained mTBI with one or more episodes of loss of consciousness (LOC) in combat. Comparison groups: 21 combat veterans who had definite or possible episodes of mTBI without LOC and 21 veterans who sustained mTBI with LOC as civilians.

Results Among combat veterans with mTBI, 52% had NDs, 66% had PTSD and 50% had PTSD and an ND. Impaired olfaction was the most common ND, found in 65 veterans. The prevalence of an ND or PTSD correlated with the number of mTBI exposures with LOC. The prevalence of an ND or PTSD was >90% for more than five episodes of LOC. Severity of PTSD and impairment of olfaction increased with number of LOC episodes. The prevalence of an ND for the 34 combat veterans with one episode of LOC (4/34=11.8%) was similar to that of the 21 veterans of similar age and educational background who sustained civilian mTBI with one episode of LOC (2/21=9.5%, p-NS).

Conclusions Impaired olfaction was the most frequently recognised ND. Repeated episodes of combat mTBI were associated with increased likelihood of PTSD and an ND. Combat setting may not increase the likelihood of an ND. Two possible connections between mTBI and PTSD are (1) that circumstances leading to combat mTBI likely involve severe psychological trauma and (2) that altered cerebral functioning following mTBI may increase the likelihood that a traumatic event results in PTSD.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2011-000312

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    Footnotes

    • Prepublication history and additional appendices for this paper are available online. To view these files please visit the journal online (http://dx.doi.org/10.1136/bmjopen-2011-000312).

    • To cite: Ruff RL, Riechers RG II, Wang X-F, et al. A case–control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI. BMJ Open 2012;2:e000312. doi:10.1136/bmjopen-2011-000312

    • Contributors RLR examined the subjects, collected data, did data analysis and wrote the manuscript. RGR II edited the manuscript, assisted with data interpretation and wrote portions of the discussion. X-FW did the statistical analysis and edited the portions of the manuscript related to statistical analysis. TP examined subjects and edited the manuscript. SSR examined subjects, assisted with study design and edited the manuscript.

    • Funding RLR is the Medical Director of the Functional Electrical Stimulation Center of Cleveland, which is supported by a Center of Excellence Award from the Rehabilitation Research and Development Service of the Office of Research and Development of the Department of Veterans Affairs. X-FW was retained as a biostatistician for the Functional Electrical Stimulation Center of Cleveland. His involvement on this project was supported by funding from the Department of Veterans Affairs through the Center of Excellence Award to the Functional Electrical Stimulation Center of Cleveland. The work in this manuscript was supported through funding for the care of veterans from the Veterans Health Administration. RLR and SSR and RGR and TP are salaried clinicians of the Veterans Health Administration.

    • Competing interests There were no other actual or potential conflicts of interest for the authors that could have inappropriately influenced the present work. Subjects and their medical records were treated in accordance with internal review board approved policies and procedures. Standard professional and ethical guidelines were upheld during the research study and manuscript preparation. The views expressed in this article do not necessarily reflect those of the Veterans Health Administration of the Department of Veterans Affairs of the USA or the USA government.

    • Ethics approval Ethical approval was provided by Institutional Review Board of the Cleveland VA Medical Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data used in this study are available in the form of a subject de-identified spreadsheet that can be obtained by a written request to RLR, robert.ruff1{at}va.gov.