Sequelae of Blast Events in Iraq and Afghanistan War Veterans using the Salisbury Blast Interview: A CENC Study

ABSTRACT

Objective: To comprehensively characterize blast exposure across the lifespan and relationship to TBI.

Participants: Post-deployment veterans and service members (N = 287).

Design: Prospective cohort recruitment.

Main Measures: Salisbury Blast Interview (SBI).

Results: 94.4% of participants reported at least one blast event, 75% reported a pressure gradient during a blast event. Participants reported an average of 337.7 (SD = 984.0) blast events (range 0–4857), 64.8% occurring during combat. Across participants, 19.7% reported experiencing a traumatic brain injury (TBI) during a blast event. Subjective ratings of blast characteristics (wind, debris, ground shaking, pressure, temperature, sound) were significantly higher when TBI was experienced and significantly lower when behind cover. Pressure had the strongest association with resulting TBI (AUC = 0.751). Pressure rating of 3 had the best sensitivity (.54)/specificity (.87) with TBI. Logistic regression demonstrated pressure, temperature and distance were the best predictors of TBI, and pressure was the best predictor of primary blast TBI.

Conclusion: Results demonstrate the ubiquitous nature of blast events and provide insight into blast characteristics most associated with resulting TBI (pressure, temperature, distance). The SBI provides comprehensive characterization of blast events across the lifespan including the environment, protective factors, blast characteristics and estimates of distance and munition.

KEYWORDS:

• Explosion
• traumatic brain injury
• military
• assessment

Acknowledgments

We would like to thank the veterans and service members who participated in this research. We would also like to thank Mary Peoples, David J. Curry, MSW, Alana M. Higgins, MA, Christine Sortino, MS, and G. Melissa Evans, MA, for their contributions to this project.

Declaration Statement

The authors declare no conflicts of interest, financial or otherwise. No competing financial interests exist.

Additional information

Funding

This research was supported by grant funding from Department of Defense, Chronic Effects of Neurotrauma Consortium (CENC) Award [W81XWH-13-2-0095] and Department of Veterans Affairs CENC Award I01 CX001135-01 [I01RX002172-01]. This research was also supported by the Salisbury VA Health Care System and Mid-Atlantic (VISN 6) Mental Illness Research, Education, and Clinical Center (MIRECC).