Follow-Up Study of Head Wounds in World War II, by a. Earl Walker and Seymour Jablon (1961) / Chapter Skim
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Method and Materials
Method and Materials
Pages 5-34
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From page 5... ...
Since the Army files did not supply adequate numbers of cases for the clinical centers, the roster was supplemented by men drawn from lists of veterans receiving disability compensation from the Veterans Administration. Each of the more than 60 regional offices of the Veterans Administration maintains lists of the veterans of the area who receive a disability compensation or pension.
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From page 6... ...
Lists were obtained from the Veterans Administration which included all men who resided in the study cities and who were, in 1950, receiving disability compensation for one of these disorders. The number of men allocated to the 4 centers from the "VA roster" were: Baltimore 157 New York 107 Boston 93 Los Angeles 112 Total 469 After review of the records of men drawn from the VA roster had begun, it became plain that this roster included many men who had suffered noncombat injuries -- falls and the like.
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From page 7... ...
Depth of Wound. In almost 30 percent of the cases, only the scalp was overtly involved in the trauma; in another 19.4 percent, there was cranial fracture without deeper penetration; and in 2.6 percent, although the dura mater was torn, there was no obvious evidence of damage to the underlying brain tissue.
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From page 8... ...
13 1.4 24 7 fi Brain 410 44. 0 Total 932 100.0 Table 4. -- Size of Cranial Defect Average diameter of cranial defect Number Percent Average diameter of cranial defect Number Percent No defect 347 37.2 >4 cm 100 10.7 22 2 4 72 7.7 <2 Cm 157 16 8 2-4 cm 234 25 1 Total 932 99.9 78 (70.3 percent)
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From page 9... ...
In 42 cases the presence of complications of the head wound could not be determined, but in the remaining 890, for which this factor was known, in 707 cases, or 79.4 percent, there were no complications. The complications most frequently noted were intracranial hemorrhage and herniation of brain tissue, each present in 88 cases, or 48.1 percent of the 183 men known to have had complications.
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From page 10... ...
. Three men had draining sinuses, three had abscesses, and one had intracranial bleeding.
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From page 11... ...
In 151 cases (33.7 percent) intracranial metallic foreign bodies were present, usually (104 cases)
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From page 12... ...
Pneumoencephalograms had been performed in Army hospitals on 129 of the men. These were usually made within 6 months of the head injury, although in 23 instances they were made after this time.
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From page 13... ...
Table 10. -- Neurological Abnormalities at Discharge From Service ; . Finding Number of men Finding Number of men Hemiplegia or hemiparesis .
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From page 14... ...
C THE FOLLOW-UP EXAMINATION After the identification of those veterans who resided in one of the 4 selected areas, their names and current addresses were supplied to the clinical centers, whose responsibility it was to persuade the men to report for examination.
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From page 15... ...
The practice of having the clinical centers enter examination results in coded form has both advantages and drawbacks. Reports in narrative style often lack the specificity which is needed for later coding.
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From page 16... ...
Table 17 presents an extract of these data. The men who were examined did not differ in age from those who were not examined, but they more often had penetrating or perforating wounds, as opposed to scalp lacerations; they more often had large cranial defects, definite penetration of brain tissue, and epileptic seizures before discharge from the Army.
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From page 17... ...
Table 17. -- Comparison of Respondents With Nonrespondents; Date From Army Clinical Records Characteristic Respondents Number Percent Nonrespondents Number Percent Total <20 years old at injury 30 + years old at injury With perforating wound With penetrating wound With scalp laceration No cranial defect Cranial defect >4 cm. diameter No penetration of brain tissue Definite penetration of brain No fits prior to separation At least 1 fit in service Posttraumatic syndrome at separation Other or unknown symptoms at separation.
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From page 18... ...
... Parasthesias 17.8 20.9 12.3 22.0 Impaired hearing or deafness Psychiatric status: Normal 143 14 120 39.8 3.9 33.4 39 8 34.2 7.0 36.8 Aoathv Anxiety 42 Neurological examination: Aphasia 38 19 34 109 44 48 12 14 30 74 10.6 5.3 9.5 '30.4 12.3 13.4 3.3 3.9 8.4 20.6 9 7 12 23 9 17 2 5 6 30 7.9 6.1 10.5 '20.2 7.9 14.9 1.8 4.4 5.3 26.3 Impaired facial movement Paralyzed or impaired motor power.
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From page 19... ...
Table 19. -- Comparison of Respondents With Nonrespondents; Data From Telephone Interview for Nonrespondents Respondents Nonrespondents for examination but with telephone interview Information from telephone interview Number Percent Number Percent Total 739 100.0 116 100.0 Employment status: 8 110 1.1 Unemployed or occasional jobs 14.9 78.1 20 96 17.2 82.8 Employed regularly .... 577 Clinical symptomatology: Posttraumatic syndrome 419 256 64 »56.7 134.6 8.7 22 79 15 119.0 168.1 12.9 No symptoms ....
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From page 20... ...
. More than one-fourth of the Los Angeles patients gave a history of having been knocked unconscious prior to the head injury which brought them into this study; only 6.8 percent of the men seen at the other centers related a history of having been knocked out.
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From page 21... ...
; the Boston center classified many more men as "none" or "regression" (71.7 percent) than did any other center, while Table 21. -- History of Previous Head Injuries Numbe r of men Numbei of men Type of injury Type of injury Los Angeles Other centers Los Angeles Other None significant Knocked out once or twice 77 19 580 42 Severe head injury without sequelae .
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From page 22... ...
Table 22. -- History of Previous Illness Condition reported Number of men Baltimore New York Boston Los Angeles None, other than uncomplicated childhood diseases 224 209 115 87 Childhood diseases with neurological complications 2 1 3 2 4 1 1 Febrile convulsions 1 3 Allecgic conditions 16 1 12 15 2 6 20 2 1 1 Syphilis 6 1 3 Other 1 Unknown 2 1 2 2 Total men 257 221 152 109 New York so classified relatively few (30.3 percent)
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From page 23... ...
Thus, at -- Baltimore twice as many men were labeled asocial as were given the former a Arc designation, while at New York the ratio was more than reversed. Table 24. -- Work Status at Time of Examination I Work status Vumber of mei I Baltimore Los Angeles Boston and New York 27 9 53 Army or VA hospital 1 4 3 Return to former job, or advanced in former job 15 13 13 56 20 72 20 9 21 New work 121 51 207 Occasional jobs 17 2 2 Unknown 1 2 Total 257 109 373 Table 25. -- Changes in Work Status Trend Number of men HJJUJ"rca# Baltimore New York Boston Los Angeles tol*
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From page 24... ...
. Table 28. -- Assessment of Economic Adjustment Adjustment Number of men Baltimore New York Boston Los Angeles Satisfactory ...
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From page 25... ...
. 739 739 The Los Angeles center was clearly less sensitive to complaints referable to other systems with the single exception of the peripheral nervous system.
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From page 26... ...
The difference among centers in the proportions reported to have homonymous hemianopsia is statistically significant at the 5 percent level. The examination of variability between centers, demonstrating differences between examiners, not only for subjective judgments but also for Table 32. -- Examiner's Assessment of Mental Status Status Number of men Baltimore New York Boston Los Angeles Normal 228 147 35 78 1 8 4 1 2 Uncooperative 2 14 2 2 1 1 Depression 4 9 1 Wisecracking Impaired judgment or mentation, or lack of concentration 3 2 48 12 10 2 16 6 Irritability Abnormal finding not due to head wound 6 10 4 105 3 Other and unknown 1 Total men 257 221 152 109 26
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From page 27... ...
Table 33. -- Results of Memory and Serial 7 Test Number of men Number of men Number of errors Number of errors Memory Serial 7 test Memory Serial 7 test None 204 244 127 68 22 14 8 9 333 129 75 53 39 16 15 11 8 9 8 1 9 3 7 14 2 >10 17 3 Not done or unsatisfactory 4 14 39 5 6 Total 739 739 7 Table 34. -- Assessment of Aphasia at Follow-up Number of men Type Baltimore New York and Boston Los Angeles None 242 337 89 Expressive 2 14 6 Nominal 5 1 Global 7 12 9 Combinations 3 2 Other and unknown 3 3 4 Total 257 373 109 Table 35. -- Assessment of Vision at Follow-up Vision Baltimore and Boston New York Los Angeles 359 168 90 Blind 4 3 i Vision impaired 9 13 Homonymous hcmianopsia 28 24 14 Other, unknown, and defects not due to head wound 14 17 5 Total men .
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From page 28... ...
On the other hand, the very great variation in the proportions of psychiatric diagnoses assigned by the centers hardly allows any conclusion but that standards varied between examiners. This is not unexpected, since the examiners in the various centers had different specialty backgrounds, representing psychiatry, neurology, and neurological surgery.
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From page 29... ...
The final score for the category was obtained from the raw score by first multiplying by the ratio of the mean difference between men with and without epilepsy to the variance of the raw scores in all 932 men, and then subtracting a suitable constant so that the category corresponding to the least severe injury would have a score of zero. The procedure may be expressed algebraically more understandably than in prose : Let Ti be the percent with epilepsy in the ith category.
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From page 30... ...
Ventricle Second head wound: None, or not involving frontal or temporal regions 882 50 174 18 19.7 36.0 0 41 Of frontal or temporal region Immediate complications: None 707 116 16.4 0 Hematoma, frank infection, abscess, 126 11 39 4 33 31.0 36.4 32 46 50 Meningitis or cerebrospinal fluid leak .
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From page 31... ...
, those drawn from the VA rosters were much more likely to have fits than those who came from the Army admissions lists (table 38)
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From page 32... ...
8-" r^ oa .«. I Numbe -« Q iu k O a '5*
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From page 33... ...
Hence, if the material be taken as a whole, it would be impossible to know to what extent correlations between these two factors were fortuitous and to what extent the brain wave tracings were actually revealing inherent characteristics related to epilepsy. No post hoc survey, such as the present study, can ever hope really to free itself of such difficulties, but it is believed that here it has been possible to minimize these disturbances by means of controlling tabulations by the R-I groups.
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