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INDEX A Abbreviated Injury Scale (AIS), 41, 45, 60, Adult traumatic brain injury, epidemiology of, 59â102 Afghanistan. See Operation Enduring Freedom Aggressive behavior, 289â291 primary studies, 289â290 secondary studies, 290â291 summary and conclusion, 293 Alcohol abuse. See Drug and alcohol abuse disorders Alzheimer's disease (AD). See Dementia of the Alzheimer type Amnesia. See Posttraumatic amnesia Amyotrophic lateral sclerosis (ALS), 254â255 secondary studies, 254 summary and conclusion, 255 Animal studies, 104 Anxiety disorders, 281â289 primary studies, 281â283 secondary studies, 283â284 summary and conclusion, 284 B Behavioral Outcome of Head Injury, 134â136 Biology of traumatic brain injury, 19â57 basic mechanisms of explosive injuries, 31â41 classification according to biomechanics of injury, 27â28 classification according to extent of pathology, 25â27 pathobiology of traumatic brain injury, 19â25 severity scoring of blast injuries and traumatic brain injury, 41â45 summary of pathobiology of traumatic brain injury, 29 therapeutics and traumatic brain injury, 28â29 traumatic brain injuries relevant to the military, 30â31 Biomarkers, 25 Biomechanics of injury, 27â28 closed injury, 27â28 penetrating and perforating injuries, 28 Bipolar disorder, 269. See also Mood disorders 373
374 GULF WAR AND HEALTH Blast-induced neurotrauma (BINT), 36â41 diffuse brain injury, 41 experimental and clinical studies of, 8â9, 370â371 penetrating traumatic brain injury, 40â41 primary blast-induced neurotrauma, 37â40 recommendations concerning, 370â371 severity scoring of, 45 Brain injury severity, 63â64 severity distributions, 64 Brain tumors and traumatic brain injury, 350â363 primary studies, 350â354 secondary studies, 354â355 summary and conclusions, 355 Brief Traumatic Brain Injury Screen, 8, 44â45, 370 C Canadian Study of Health and Aging (CSHA), 129â130 Case-control studies, 109â110 nested, 110 Case-fatality rates (CFRs), 68 Categories of associations, 112â113 inadequate/insufficient evidence to determine whether an association exists, 113 limited/suggestive evidence of an association, 112 limited/suggestive evidence of no association, 113 sufficient evidence of a casual relationship, 112 sufficient evidence of an association, 112 Caveness. See W.F. Caveness studies of Korean War veterans Classification according to biomechanics of injury, 27â28 closed injury, 27â28 penetrating and perforating injuries, 28 Classification according to extent of pathology, 25â27 pathologic features of diffuse traumatic brain injury, 26â27 pathologic features of focal traumatic brain injury, 25â26 Cohort studies, 117â172 Bryant and Harvey studies, 133â134, 155â156 general limitations of, 117â118 Jennett (Oxford, Rotterdam, Cardiff, and Manchester) studies, 137â138, 163â164 military studies, 118â127 one type of observational-study design, 108â109 population-based, 127â133 Roberts (Oxford, UK) studies, 138â140, 162â163 of sports-related traumatic brain injury, 140â165 University of Washington longitudinal traumatic brain injury studies, 134â137, 156â162 Computed tomography (CT), of brain lesions, 60 Conclusions and recommendations, 367â372
INDEX 375 Cross-sectional studies, 110 D Dementia of the Alzheimer type, 237â242 primary study, 237â238 secondary studies, 238â240 Dementia pugilistica (DP), 243â246 secondary studies, 244â245 summary and conclusions, 245â246 Diabetes insipidus, 231. See also Endocrine disorders Diffuse traumatic brain injury, 26â27, 41 Diffusion-tensor imaging (DTI), 21â22 Dilantin Prophylaxis of Post-Traumatic Seizures, 134â136 Dizziness, 218. See also Postconcussion symptoms Dose-response relationships, in inferring causality, 107â108 Drug and alcohol abuse disorders, 291 secondary studies, 291 summary and conclusions, 293 Dynamic loading, 27â28 E E.A. Walker's studies of head-injured veterans from World War I, 119, 143 from World War II, 119â121, 144â145 Endocrine disorders, 227â236 diabetes insipidus, 231 growth hormone insufficiency, 231â232 hypopituitarism, 231 primary studies, 227â230 secondary studies, 230â231 summary and conclusions, 231â232 Epidemiologic studies, 105 Epidemiology of adult traumatic brain injury, 59â102 brain injury severity, 63â64 gross severity of traumatic brain injury, 59â60 incidence of traumatic brain injury, 61â63 outcome scores and predictors, 60 recurrent traumatic brain injury, 67â68 risk factors for traumatic brain injury, 64â67 scales and scoring systems used to describe traumatic brain injury, 59 summary, 69 traumatic brain injury and short-term outcomes, 68â69
376 GULF WAR AND HEALTH Experimental studies in penetrating traumatic brain injury, 40â41 in primary blast-induced neurotrauma, 37â39 F Finnish studies, 121, 145 Focal traumatic brain injury, 25â26 Functional status, 312â313 Functioning of relatives, 313â314 G Generalized anxiety disorder (GAD), 281. See also Anxiety disorders Glasgow Coma Scale (GCS), 42â43, 59â60 eye opening, 42â43 motor response, 43 overall score, 43 in scoring severity of TBI, 42â43 verbal response, 43 Glasgow Outcome Scale (GOS), 60, 69â70 Growth hormone insufficiency, 231â232. See also Endocrine disorders Gulf War and Health, previous volumes in series, 1â2, 13â14 H "Healthy-warrior effect," 109 Hematomas, 25â26 Hypopituitarism, 231. See also Endocrine disorders I Incidence of traumatic brain injury, 61â63 mortality, 62 prevalence, 62â63 time trends, 61â62 Inclusion criteria, 110â111 exposure assessment, 111 methodologic rigor, 111 outcome (health effect) assessment, 111 Independent living, 310, 315 Injury Severity Score (ISS), 41 Intracranial meningioma. See Brain tumors and traumatic brain injury Iraq War. See Operation Iraqi Freedom
INDEX 377 Irritability. See Postconcussion symptoms K Korean War veterans, W.F. Caveness studies of, 123, 147 L Leisure activities, 311â312 Limitations of the studies, 4â5, 113â114 Lou Gehrig's disease. See Amyotrophic lateral sclerosis M Mania, 269. See also Mood disorders Mayo Classification System, 43 Mechanisms of explosive injuries, 31â33 blast-induced neurotrauma, 36â41 general medical effects, 33â36 physics, 31â33 Memory impairment. See Postconcussion symptoms Military Acute Concussion Evaluation (MACE), 45, Military studies, cohorts, 118â127 Finnish, 121, 145 of head-injured Bavarian World War I veterans, 119, 143 of head-injured World War II veterans, 119â121, 144â145 of Korean War veterans, 123, 147 Teuber's cohort, 121â122, 146 Vietnam Experience Study, 125â127, 150 Vietnam Head Injury Study (VHIS), 124â125, 148â149 Millennium Cohort Study, 16 Mood disorders, 266â275 primary studies, 266â268 secondary studies, 268â269 summary and conclusion, 269 Mortality and traumatic brain injury, 333â349. See also Premature mortality in civilian populations, 334â336 in military populations, 333â334 primary studies, 333â336 secondary studies, 336â338 summary and conclusions, 339 Motor response, in the Glasgow Coma Scale, 43 Multiple sclerosis, 251â253 primary study, 251 secondary study, 251
378 GULF WAR AND HEALTH summary and conclusion, 251â252 N National Institutes of Health, Traumatic Coma Databank (TCDB), 132â133 Nested case-control studies, 110, 266 Neurocognitive outcomes, 173â196 closed head injury, 181â193 penetrating brain injury, 173â180 Neurodegenerative diseases, 237â255 amyotrophic lateral sclerosis, 254â255 dementia of the Alzheimerâs type, 237â242 dementia pugilistica, 243â246 multiple sclerosis, 251â253 parkinsonism, 246â250 Neurologic outcomes, 197â263 endocrine disorders, 227â236 neurodegenerative diseases, 237â255 ocular and visual motor deterioration, 224â226 postconcussion symptoms, 210â223 seizure disorders, 197â209 O Observational-study designs case-control studies, 109â110 cohort studies, 108â109 cross-sectional studies, 110 standardized mortality studies, 109 Ocular and visual motor deterioration, 224â226 primary studies, 224 secondary studies, 224â225 summary and conclusion, 225 Operation Enduring Freedom (OEF), 1, 3, 13, 15, 30 Operation Iraqi Freedom (OIF), 1, 3, 13, 15, 30 Overpressure effects, on surrounding materials and unprotected persons, 32â33 P Parkinsonism, 246â250 primary studies, 246â247 secondary studies, 248 summary and conclusion, 248 Pathobiology of traumatic brain injury, 19â25
INDEX 379 Pathologic features of diffuse traumatic brain injury, 26â27 of focal traumatic brain injury, 25â26 Pathology Scoring System (PSS), 42, 45 Patient Characteristics and Head Injury Outcome, 134â136 Patient Health Questionnaire (PHQ-15), 211 Penetrating traumatic brain injury from blast-induced neurotrauma, 40â41 clinical studies, 41 experimental studies, 40â41 Persian Gulf War Veterans Act, 1, 13 Physics, of the mechanisms of explosive injuries, 31â33 Population-based studies, cohorts, 127â133 Canadian Study of Health and Aging (CSHA), 129â130, 153 community-based study of injuries in the Aquitaine, France, 128â129, 152 Rochester Epidemiology Project, 127â128, 150â151 Traumatic Brain Injury Model Systems (TBIMS), 130â132, 153â154 Traumatic Coma Databank (TCDB), 132â133, 154â155 Postconcussion symptoms (PCSs), 210â223 primary studies, 210â217 secondary studies, 217 summary and conclusions, 217â218 Postdeployment testing, recommendations concerning, 9â10, 372 Posttraumatic epilepsy. See Seizure disorders Posttraumatic ischemia, 24 Predeployment testing, recommendations concerning, 9â10, 372 Predictors, of outcomes, 60 Premature mortality. See Mortality and traumatic brain injury Prevalence of traumatic brain injury (disability), 62â63 Primary blast-induced neurotrauma, 37â40 clinical studies, 39â40 experimental studies, 37â39 Psychiatric outcomes, 265â300 aggressive behaviors, 289â291 anxiety disorders, 281â289 drug and alcohol abuse disorders, 291 mood disorders, 266â275 suicide, 276â280 Psychotic disorders, 292â296 primary studies, 292 secondary studies, 292 summary and conclusions, 293 Punch-drunk syndrome, 243
380 GULF WAR AND HEALTH R Recommendations, 7â10, 370â372 experimental and clinical studies of blast-induced neurotrauma, 8â9, 370â371 predeployment and postdeployment testing, 9â10, 372 registry control groups, 9, 371â373 scoring of severity of blast-induced neurotrama, 7â8, 370 Recurrent traumatic brain injury, 67â68 Red Cross Wound Classification (RCWC), 42 Registry. See Traumatic Brain Injury Veterans Health Registry Registry control groups, recommendations concerning, 9, 371â373 Risk factors for traumatic brain injury, 64â67 external causes of traumatic brain injury, 66 military exposures, 66â67 Rochester Epidemiology Project, 127â128 S Scope of the report, 15 Scores, of outcomes, 59â60 Scoring of severity of blast-induced neurotrama, recommendations concerning, 7â8, 370 Seizure disorders, 197â209 primary studies, 197â200 secondary studies, 200â202 summary and conclusion, 202â203 Severity-of-injury index (SII), 42 Severity of brain injury, 63â64 scoring of BINT, 45 scoring of blast injuries, 41â42 scoring of traumatic brain injury, 42â45 Short-term outcomes, traumatic brain injury and, 68â69 case-fatality rates, 68 disposition at the end of acute care, 69 Social functioning, 301â331 primary studies of civilian populations, 303â307 primary studies of military populations, 301â303 secondary studies, 307â314 summary and conclusions, 314â327 Social relationships, 310â311 Spallation, 32â33 Sports-related traumatic brain injury, 140â165, 183-186 boxing, 141â142, 165 football, 140â141, 164 soccer, 142 Standardized mortality studies, 109
INDEX 381 Strength of the evidence categories of associations, 112â113 considerations in assessing, 112â113 Suicide, 276â280 primary studies, 276 secondary studies, 277 summary and conclusions, 277â278 T Teuber's cohort, 121â122, 146 Therapeutics, and traumatic brain injury, 28â29 Time trends, in incidence of traumatic brain injury, 61â62 Traumatic Brain Injury Model Systems (TBIMS), 130â132, 153â154 Traumatic Brain Injury Veterans Health Registry, 9 U Unemployment, long-term, 314â315. See also Functional status V Valproate Prophylaxis of Post-Traumatic Seizures, 135â136 Verbal response, in the Glasgow Coma Scale, 43 Vertigo, positional, 139 Veterans Programs Enhancement Act, 1, 13 Vietnam Experience Study (VES), 125â127, 150 Vietnam Head Injury Study (VHIS), 124â125, 148â149 W Walker. See E.A. Walker's studies of head-injured veterans Walter Reed Army Institute of Research, Blast Injury Subjective Score, 42 Walter Reed Army Medical Center, 3, 14 W.F. Caveness studies of Korean War veterans, 123, 147 World Health Organization, Collaborating Task Force on Mild Traumatic Brain Injury, 2, 14