Rael T Lange1,2,3,4,5, Louis M French6,7,8,9, Jason M Bailie6,10,11, Victoria C Merritt12,13, Cassandra L Pattinson14, Lars D Hungerford6,15,11, Sara M Lippa7,8, Tracey A Brickell6,7,8,9,11. 1. Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA. rael.lange@gmail.com. 2. Walter Reed National Military Medical Center, Bethesda, MD, USA. rael.lange@gmail.com. 3. National Intrepid Center of Excellence, Bethesda, MD, USA. rael.lange@gmail.com. 4. University of British Columbia, Vancouver, BC, Canada. rael.lange@gmail.com. 5. General Dynamics Information Technology, Falls Church, VA, USA. rael.lange@gmail.com. 6. Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA. 7. Walter Reed National Military Medical Center, Bethesda, MD, USA. 8. National Intrepid Center of Excellence, Bethesda, MD, USA. 9. Uniformed Services University of the Health Sciences, Bethesda, MD, USA. 10. Naval Hospital Camp Pendleton, Oceanside, CA, USA. 11. General Dynamics Information Technology, Falls Church, VA, USA. 12. VA San Diego Healthcare System, San Diego, CA, USA. 13. University of California San Diego, La Jolla, CA, USA. 14. University of Queensland, Brisbane, QLD, Australia. 15. Naval Medical Center San Diego, San Diego, CA, USA.
Abstract
PURPOSE: This study examined the clinical utility of post-traumatic stress disorder (PTSD), low resilience, poor sleep, and lifetime blast exposure as risk factors for predicting future neurobehavioral outcome following traumatic brain injury (TBI). METHODS: Participants were 591 U.S. military service members and veterans who had sustained a TBI (n = 419) or orthopedic injury without TBI (n = 172). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and the TBI-Quality of Life (TBI-QOL) scale at baseline and follow-up. RESULTS: Using the four risk factors at baseline, 15 risk factor combinations were examined by calculating odds ratios to predict poor neurobehavioral outcome at follow-up (i.e., number of abnormal scores across five TBI-QOL scales [e.g., Fatigue, Depression]). The vast majority of risk factor combinations resulted in odds ratios that were considered to be clinically meaningful (i.e., ≥ 2.5) for predicting poor outcome. The risk factor combinations with the highest odds ratios included PTSD singularly, or in combination with poor sleep and/or low resilience (odds ratios = 4.3-72.4). However, poor sleep and low resilience were also strong predictors in the absence of PTSD (odds ratios = 3.1-29.8). CONCLUSION: PTSD, poor sleep, and low resilience, singularly or in combination, may be valuable risk factors that can be used clinically for targeted early interventions.
PURPOSE: This study examined the clinical utility of post-traumatic stress disorder (PTSD), low resilience, poor sleep, and lifetime blast exposure as risk factors for predicting future neurobehavioral outcome following traumatic brain injury (TBI). METHODS: Participants were 591 U.S. military service members and veterans who had sustained a TBI (n = 419) or orthopedic injury without TBI (n = 172). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and the TBI-Quality of Life (TBI-QOL) scale at baseline and follow-up. RESULTS: Using the four risk factors at baseline, 15 risk factor combinations were examined by calculating odds ratios to predict poor neurobehavioral outcome at follow-up (i.e., number of abnormal scores across five TBI-QOL scales [e.g., Fatigue, Depression]). The vast majority of risk factor combinations resulted in odds ratios that were considered to be clinically meaningful (i.e., ≥ 2.5) for predicting poor outcome. The risk factor combinations with the highest odds ratios included PTSD singularly, or in combination with poor sleep and/or low resilience (odds ratios = 4.3-72.4). However, poor sleep and low resilience were also strong predictors in the absence of PTSD (odds ratios = 3.1-29.8). CONCLUSION: PTSD, poor sleep, and low resilience, singularly or in combination, may be valuable risk factors that can be used clinically for targeted early interventions.
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