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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)

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

Methods:
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.

Results:
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).

Implications:
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.

Impacts:
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.