Initial Mild Traumatic Brain Injury Characteristics and Recovery Patterns Among Females Across the United States Military Service Academies: A Report from the NCAA-DoD CARE Consortium

doi:10.1007/s10439-023-03374-z

. 2024 Oct;52(10):2756-2767.

doi: 10.1007/s10439-023-03374-z. Epub 2023 Sep 24.

Initial Mild Traumatic Brain Injury Characteristics and Recovery Patterns Among Females Across the United States Military Service Academies: A Report from the NCAA-DoD CARE Consortium

Landon B Lempke^{1

2

3}, Elsa Ermer^{4

5}, Adrian J Boltz⁶, Jaclyn Caccese⁷, Thomas A Buckley⁸, Kenneth L Cameron⁹, Sara P D Chrisman¹⁰, Christopher D'Lauro¹¹, James T Eckner¹², Carrie Esopenko¹³, Tamerah N Hunt¹⁴, Divya Jain¹³, Louise A Kelly¹⁵, Allyssa K Memmini¹⁶, Anne E Mozel¹⁷, Margot Putukian¹⁸, Adam Susmarski¹⁹, Paul F Pasquina⁵, Michael A McCrea²⁰, Thomas W McAllister²¹, Steven P Broglio⁶, Christina L Master^{17

22}

Affiliations

¹ Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA. llempke@umich.edu.
² Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA. llempke@umich.edu.
³ , 830 North University Avenue, Suite 4000, Ann Arbor, MI, 48109, USA. llempke@umich.edu.
⁴ Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
⁵ Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
⁶ Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
⁷ School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA.
⁸ Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
⁹ Keller Army Hospital and United States Military Academy, West Point, NY, USA.
¹⁰ Division of Adolescent Medicine, University of Washington, Seattle, WA, USA.
¹¹ Department of Behavioral Science and Leadership, United States Air Force Academy, USAF Academy, El Paso County, CO, USA.
¹² Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
¹³ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁴ Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, USA.
¹⁵ Department of Exercise Science, California Lutheran University, Thousand Oaks, CA, USA.
¹⁶ Department of Health, Exercise & Sports Sciences, University of New Mexico, Albuquerque, NM, USA.
¹⁷ Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁸ Major League Soccer, Princeton, NJ, USA.
¹⁹ Department of Orthopedics and Sports Medicine, United States Naval Academy, Annapolis, MD, USA.
²⁰ Center for Neurotrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
²¹ Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
²² Orthopaedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

PMID: 37743459
DOI: 10.1007/s10439-023-03374-z

Initial Mild Traumatic Brain Injury Characteristics and Recovery Patterns Among Females Across the United States Military Service Academies: A Report from the NCAA-DoD CARE Consortium

Landon B Lempke et al. Ann Biomed Eng. 2024 Oct.

. 2024 Oct;52(10):2756-2767.

doi: 10.1007/s10439-023-03374-z. Epub 2023 Sep 24.

Authors

Affiliations

¹ Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA. llempke@umich.edu.
² Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA. llempke@umich.edu.
³ , 830 North University Avenue, Suite 4000, Ann Arbor, MI, 48109, USA. llempke@umich.edu.
⁴ Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
⁵ Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
⁶ Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
⁷ School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA.
⁸ Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
⁹ Keller Army Hospital and United States Military Academy, West Point, NY, USA.
¹⁰ Division of Adolescent Medicine, University of Washington, Seattle, WA, USA.
¹¹ Department of Behavioral Science and Leadership, United States Air Force Academy, USAF Academy, El Paso County, CO, USA.
¹² Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
¹³ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁴ Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, USA.
¹⁵ Department of Exercise Science, California Lutheran University, Thousand Oaks, CA, USA.
¹⁶ Department of Health, Exercise & Sports Sciences, University of New Mexico, Albuquerque, NM, USA.
¹⁷ Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁸ Major League Soccer, Princeton, NJ, USA.
¹⁹ Department of Orthopedics and Sports Medicine, United States Naval Academy, Annapolis, MD, USA.
²⁰ Center for Neurotrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
²¹ Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
²² Orthopaedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

PMID: 37743459
DOI: 10.1007/s10439-023-03374-z

Abstract

Mild traumatic brain injury (mTBI) has been described in the United States (US) military service academy cadet population, but female-specific characteristics and recovery outcomes are poorly characterized despite sex being a confounder. Our objective was to describe female cadets' initial characteristics, assessment performance, and return-to-activity outcomes post-mTBI. Female cadets (n = 472) from the four US military service academies who experienced a mTBI completed standardized mTBI assessments from pre-injury to acute initial injury and unrestricted return-to-duty (uRTD). Initial injury presentation characteristics (e.g., delayed symptoms, retrograde amnesia) and return-to-activity outcomes [i.e., return-to-learn, initiate return-to-duty protocol (iRTD), uRTD] were documented. Descriptive statistics summarized female cadets' injury characteristics, return-to-activity outcomes, and post-mTBI assessment performance change categorization (worsened, unchanged, improved) relative to pre-injury baseline using established change score confidence rank criteria for each assessment score. The median (interquartile range) days to return-to-learn (n = 157) was 7.0 (3.0-14.0), to iRTD (n = 412) was 14.7 (8.6-25.8), and to uRTD (n = 431) was 26.0 (17.7-41.8). The majority experienced worse SCAT total symptom severity (77.8%) and ImPACT reaction time (97.0%) acutely < 24-h versus baseline, but unchanged BESS total errors (75.2%), SAC total score (72%), BSI-18 total score (69.6%), and ImPACT verbal memory (62.3%), visual memory (58.4%), and visual motor speed (52.5%). We observed similar return-to-activity times in the present female cadet cohort relative to the existing female-specific literature. Confidence ranks categorizing post-mTBI performance were heterogenous and indicate multimodal assessments are necessary. Our findings provide clinically relevant insights to female cadets experiencing mTBI across the US service academies for stakeholders providing healthcare.

Keywords: Active duty; Concussion; Psychological; Recovery; Veteran.

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References

1. DOD TBI Worldwide Numbers. Military Health System. https://health.mil/Military-Health-Topics/Centers-of-Excellence/Traumati... . Accessed January 27, 2023.
1. Helmick, K. M., C. A. Spells, S. Z. Malik, C. A. Davies, D. W. Marion, and S. R. Hinds. Traumatic brain injury in the US military: epidemiology and key clinical and research programs. Brain Imaging Behav. 9(3):358–366, 2015. https://doi.org/10.1007/s11682-015-9399-z . - DOI - PubMed
1. US Department of Health & Human Services, Centers for Disease Control (CDC), National Center for Injury Prevention and Control. Report to Congress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a Serious Public Health Problem: (371602004-001). https://doi.org/10.1037/e371602004-001( Published online 2003)
1. O’Connor, K. L., M. M. Baker, S. L. Dalton, T. P. Dompier, S. P. Broglio, and Z. Y. Kerr. Epidemiology of sport-related concussions in high school athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 through 2013–2014. J. Athl. Train. 52(3):175–185, 2017. https://doi.org/10.4085/1062-6050-52.1.15 . - DOI - PubMed - PMC
1. Chandran, A., A. J. Boltz, S. N. Morris, et al. Epidemiology of concussions in National Collegiate Athletic Association (NCAA) sports: 2014/15–2018/19. Am. J. Sports Med. 50(2):526–536, 2021. https://doi.org/10.1177/03635465211060340 . - DOI - PubMed

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[1] DOD TBI Worldwide Numbers. Military Health System. https://health.mil/Military-Health-Topics/Centers-of-Excellence/Traumati... . Accessed January 27, 2023.

[2] DOD TBI Worldwide Numbers. Military Health System. https://health.mil/Military-Health-Topics/Centers-of-Excellence/Traumati... . Accessed January 27, 2023.

[3] Helmick, K. M., C. A. Spells, S. Z. Malik, C. A. Davies, D. W. Marion, and S. R. Hinds. Traumatic brain injury in the US military: epidemiology and key clinical and research programs. Brain Imaging Behav. 9(3):358–366, 2015. https://doi.org/10.1007/s11682-015-9399-z . - DOI - PubMed

[4] Helmick, K. M., C. A. Spells, S. Z. Malik, C. A. Davies, D. W. Marion, and S. R. Hinds. Traumatic brain injury in the US military: epidemiology and key clinical and research programs. Brain Imaging Behav. 9(3):358–366, 2015. https://doi.org/10.1007/s11682-015-9399-z . - DOI - PubMed

[5] US Department of Health & Human Services, Centers for Disease Control (CDC), National Center for Injury Prevention and Control. Report to Congress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a Serious Public Health Problem: (371602004-001). https://doi.org/10.1037/e371602004-001( Published online 2003)

[6] US Department of Health & Human Services, Centers for Disease Control (CDC), National Center for Injury Prevention and Control. Report to Congress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a Serious Public Health Problem: (371602004-001). https://doi.org/10.1037/e371602004-001( Published online 2003)

[7] O’Connor, K. L., M. M. Baker, S. L. Dalton, T. P. Dompier, S. P. Broglio, and Z. Y. Kerr. Epidemiology of sport-related concussions in high school athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 through 2013–2014. J. Athl. Train. 52(3):175–185, 2017. https://doi.org/10.4085/1062-6050-52.1.15 . - DOI - PubMed - PMC

[8] O’Connor, K. L., M. M. Baker, S. L. Dalton, T. P. Dompier, S. P. Broglio, and Z. Y. Kerr. Epidemiology of sport-related concussions in high school athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 through 2013–2014. J. Athl. Train. 52(3):175–185, 2017. https://doi.org/10.4085/1062-6050-52.1.15 . - DOI - PubMed - PMC

[9] Chandran, A., A. J. Boltz, S. N. Morris, et al. Epidemiology of concussions in National Collegiate Athletic Association (NCAA) sports: 2014/15–2018/19. Am. J. Sports Med. 50(2):526–536, 2021. https://doi.org/10.1177/03635465211060340 . - DOI - PubMed

[10] Chandran, A., A. J. Boltz, S. N. Morris, et al. Epidemiology of concussions in National Collegiate Athletic Association (NCAA) sports: 2014/15–2018/19. Am. J. Sports Med. 50(2):526–536, 2021. https://doi.org/10.1177/03635465211060340 . - DOI - PubMed

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Initial Mild Traumatic Brain Injury Characteristics and Recovery Patterns Among Females Across the United States Military Service Academies: A Report from the NCAA-DoD CARE Consortium

Affiliations

Initial Mild Traumatic Brain Injury Characteristics and Recovery Patterns Among Females Across the United States Military Service Academies: A Report from the NCAA-DoD CARE Consortium

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