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Evaluation of longitudinal outcomes in mild traumatic brain injury (TBI) active-duty military and veterans
Investigator (PI): Mac Donald, Christine L
Performing Organization (PO): (Current): University of Washington, School of Medicine, Department of Neurological Surgery / (206) 221-8967
Supporting Agency (SA): National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (NINDS)
Initial Year: 2015
Final Year: 2020
Record Source/Award ID: RePorter/R01NS091618
Funding: 2015 Award Amount: $621,261
2016 Award Amount: $610,301
2017 Award Amount: $610,991
2018 Award Amount: $610,077
Award Type: Grant
Award Information: Reports resulting from this project
Abstract: In the US military, it is estimated that roughly 20% of the deployed force suffered a head injury in the wars in Iraq and Afghanistan, 83.3% of whom endured a mild, uncomplicated traumatic brain injury (TBI) or concussion. The long-term impact of these injuries is just beginning to be appreciated. Many of these service members are young males, 20-30 years old who have decades of life to live with the complex and often debilitating impact of war-time brain injury. The total lifetime health care costs are largely unknown. Although substantial effort has been placed on trying to better understand this type of injury, much research has been forced to rely largely on self-reporting, retrospective medical records review, or evaluations of only later stages of injury. No study to date has prospectively followed active-duty US military from injury to long-term outcome with advanced magnetic resonance (MR) imaging and clinical evaluation. The overall goal is to investigate long-term advanced MR imaging measures and clinical outcome of concussive traumatic brain injury sustained during deployment in US military personnel. We will relate these findings to prospectively acquired longitudinal imaging and clinical data from the acute/sub-acute, and early chronic stages following concussion collected on these patients as part of previous collaborative efforts. We hypothesize that early clinical and imaging measures will offer predictive insight into late-stage clinical outcomes. Study design: As part of previous collaborative efforts, we have successfully completed early prospective, longitudinal studies enrolling active-duty US military at 0-7 days (median 4), 0-30 days (median 8), and 0-90 days (median 14) post-injury where early advanced MR imaging (MRI) and clinical data were collected. In total, 591 subjects were enrolled through these efforts; 54% TBI, 46% control. We propose to re-examine control and TBI subjects now 5-7 years post-injury and compare their current clinical and imaging presentation with the previously acquired longitudinal data. We believe that this population offers a unique opportunity to rigorously evaluate the long-term impact of war-time concussive TBI. Aim #1 is to explore long-term evolution of neurological, neuropsychological, and psychiatric effects of mild-concussive TBI in US military personnel by analyzing clinical outcome data to be collected 5-7 years post-injury and previously prospectively acquired early clinical data. Aim #2 is to quantify the relationship between imaging biomarkers of brain injury from early and long-term advanced MRI data in US military personnel with mild-concussive TBI by analyzing diffusion tensor imaging (DTI) data acquired 5-7 years post injury and previously collected acute, sub-acute, and early chronic DTI data. Aim #3 is to develop a predictive model from combined acute, sub-acute, and early chronic clinical and imaging data for long-term outcomes following mild-concussive TBI in US military personnel.
MeSH Terms:
  • Adult
  • Afghan Campaign 2001-
  • Brain Concussion /therapy
  • Brain Injuries, Traumatic /*therapy
  • Craniocerebral Trauma /*therapy
  • Humans
  • Iraq War, 2003-2011
  • Longitudinal Studies
  • Magnetic Resonance Imaging
  • Male
  • Medical Records
  • Military Personnel
  • Outcome Assessment, Health Care
  • Prospective Studies
  • Retrospective Studies
  • Self Report
  • Time Factors
  • United States
  • Veterans
  • Young Adult
Keywords:
  • Afghanistan
  • Iraq
  • TBI patients
  • acute
  • brain concussion
  • brain injuries
  • chronic
  • chronic phase
  • clinical data
  • image analysis
  • imaging biomarker
  • long-term effects
  • longitudinal studies
  • magnetic resonance imaging
  • male
  • mild concussions
  • mild traumatic brain injury
  • military personnel
  • neurologic
  • neuropsychology
  • outcome
  • patients
  • predictive modeling
  • prospective
  • traumatic brain injury
  • veterans
  • war
Country: United States
State: Washington
Zip Code: 98195
UI: 20184197
Project Status: Completed