Careful Diagnosis at Time of Injury Is Key to Recovery

The Department of Defense is evaluating the study by Col. Charles Hoge, M.C., and colleagues about whether changes are needed in screening or treatment programs for mild traumatic brain injury and PTSD after soldiers return from combat deployments (see Blast Injury Sequelae Linked to PTSD). Cynthia Vaughan, a spokesperson for the Army Surgeon General's Office, responded to a request for comments with the following statement, which has been slightly abbreviated for space reasons:

“Full recovery from concussion (which is also known as mild traumatic brain injury—mTBI) is expected, usually in a matter of days with the initial interventions being rest, education, and protection from a subsequent injury during the period of cerebral vulnerability. It is important that the expectation of full and quick recovery be communicated to the patient....

“However, it is very important for us to record all injuries at the time of injury even if full recovery is expected. When soldiers return home, family members may think that symptoms such as irritability, fatigue, sleep problems, or forgetfulness are caused by a brain injury, when they may actually be related to posttraumatic stress or depression. These symptoms may also be normal reactions to combat or reactions that one would expect after any injury, since none of the symptoms are exclusive to the aftereffects of a brain injury. It is very important that soldiers receive the right treatment at the point of injury and throughout the continuum of care. It is incumbent on providers to identify if concussion, posttraumatic stress, or depression is affecting their patients as there are effective treatments for these disorders.

“Col. Hoge's study indicated that PTSD is more common in soldiers who had concussions than in soldiers with other types of injuries. As with civilian concussion, further research is needed to determine the effects of multiple concussions and any potential long-term effects.

“The Army continues to screen soldiers for concussions and for posttraumatic stress, as well as to train health care providers, military leaders, and soldiers to recognize symptoms of postcombat stress and concussion—and how and when to seek health care. The important thing is to address all the health concerns regardless of the cause, as well as any underlying factors that may be making symptoms worse, such as depression or posttraumatic stress.”