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2019 HSR&D/QUERI National Conference Abstract

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4024 — Potential Concussive Event Narratives of those who Served in Post-9/11 Combat: A Chronic Effects of Neurotrauma Consortium Study

Lead/Presenter: Jonathan Yee,  COIN - Bedford/Boston
All Authors: Yee JK (Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System ), Marchany K (Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System), Greenan MA (Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System) Pogoda TK (Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System)

To document the potential concussive event (PCE) experiences of Post-9/11 Service Members/Veterans deployed to combat.

Post-9/11 Service Member/Veteran participants were enrolled in the Chronic Effects of Neurotrauma Consortium (CENC) study, which examines the long-term effects of combat and mild traumatic brain injury (mTBI). We reviewed demographics and semi-structured interviews of deployment-related PCE narratives from the full VA Boston Healthcare System cohort of 106 current participants.

Participants were primarily male (92.5%), White (81.1%), non-Hispanic (90.6%), Army personnel (53.8%), were Active Duty (64.2%), averaged 1.5 combat deployments totaling 14.0 months, and were 35 years old at time of assessment. Many reported experiencing blast (51.9%), non-blast (10.4%), and both injury mechanisms (35.8%), and the majority (79.2%) experienced at least one combat-related mTBI. An in-depth qualitative analysis of participants' event narratives revealed several themes: Surviving hostile blasts at close range that would likely have been fatal in past conflicts (e.g., driving over improvised explosive devices); blast-related and non-blast events resulting in similar symptoms, such as alteration of sensory and neurological function at the time of injury (e.g., blurred or faded vision; temporary deafness; nausea) or within hours or days later (e.g., headache; memory issues; light sensitivity; dizziness); diverse non-hostile injury etiologies (e.g., controlled detonation errors; repetitive exposure to friendly explosives; human error such as hitting head on vehicle doors); and multiple non-blast combat injury etiologies (e.g., motor vehicle accidents during high speed pursuits, or unavoidable combat accidents such as buildings collapsing during a raid).

Blast-related and non-blast-related PCEs were common during combat deployment, ranging from accidental impacts with fleeting symptoms to intense close-range hostile blast exposures with acute and longer-lasting neurological sequelae. While hostile blasts comprise most of the worst events, the notable prevalence of non-hostile and non-blast events also warrants attention. Heavy vehicle use, chronic exposure to explosives, and the inherently unpredictable nature of combat conditions represent pervasive risks of head injury.

This study examines firsthand narratives of PCEs experienced during combat deployment, which comprise a rich resource for understanding contextual elements of a Service Member/Veteran's (hi)story, gaining insight into current health conditions, and strengthening Service Member/Veteran-provider communication.