A Comparison of PTSD and Mild TBI in Burned Military Service Members

The United States Institute of Surgical Research (USAISR) is the sole referral center for all significantly burned active duty military personnel. Since the start of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) 546 burned service members have been treated at the USAISR. A significant percent of the population of burned service members also sustained a blast injury. Service members who sustained a blast injury were assessed for traumatic brain injury (TBI) by staff neuropsychologists. From Sep 1, 2005 to Aug 31, 2006, 139 burned service members assessed for TBI and 57 were diagnosed with mild traumatic brain injury (mTBI). Sustaining any kind of physical injury in theater is known to increase a service member's risk for post-traumatic stress disorder (PTSD). Thus, burned service members with blast injuries have a high risk for developing PTSD. All service members admitted to the USAISR are assessed for PTSD by staff Psychiatric Nurse Practitioners. During the same timeframe stated above, 17 percent of burned service members screened positive for PTSD.

The significant numbers of military service members diagnosed with TBI and PTSD is cause for concern. Most of what is know about physical and psychological health outcomes of military service members comes from studies of veterans from the Vietnam and Persian Gulf Wars. The current conflict has multiple differences in operations, treatment, evacuation, and mortality. Additionally, this war has resulted in a progressive frequency of blast injuries because of asymmetrical, terrorist warfare with improvised explosive devices (IEDs). Currently, more than half of all combat injuries are the result of explosive munitions. Exposure to blast overpressure may result in mild to severe TBI. The actual incidence of TBI, especially mTBI in combat veterans is unknown. Mild TBI may not be identified at presentation because of delayed symptoms and the absence of radiologic abnormalities. The presence of PTSD in TBI has been examined in mild to severe injury and with covariates such as anxiety, pain, substance abuse, depression, age, and coping styles. Because there is significant overlap between the symptoms of mTBI and PTSD, and possible co-morbidity between these disorders, differential diagnosis is difficult. The proposed study is a unique opportunity to examine the relationship of mTBI and PTSD in a sample of burned military service members who also sustained a blast injury.

Combat-related information from previous conflicts does not appear to fully explain the psychosocial impact of war. Inaccurate assessment, diagnosis, and treatment of mTBI and PTSD will negatively affect service members in terms of disability and follow-up care in Veteran's Affairs facilities. Accurate and effective assessment instruments, intervention modalities, and outcome measures are needed to assist service members with the transition from combat to home. Although clinical practice guidelines and recommendations have been developed for both TBI and PTSD, further research that focuses on the differences and similarities between mTBI and PTSD is warranted. Information gained from this study might be generalized to civilians' injured in explosions. This study will advance our knowledge of the relationship of mTBI and PTSD in military service members.

Final Report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2017101...