title: Blast-related mild traumatic brain injury is associated with a decline in self-rated health amongst US military personnel.
abstract: BACKGROUND
  Mild traumatic brain injury (MTBI) has emerged as the preeminent injury of combat from the recent conflicts in Iraq and Afghanistan. Very little is known about short- and long-term outcomes after combat-related MTBI. As a measure of outcome after injury, self-rated health is a reliable, widely used measure that assesses perceived health. The primary aim of this study was to determine the effect of combat-related MTBI on self-reported health status after return from deployment. The secondary objective was to examine predictors of a decline in self-reported health status amongst US service members with MTBI, as compared to those service members with other minor non-TBI injuries.
  
  
  METHODS
  MTBI cases and an injured comparison group were identified from the Expeditionary Medical Encounter Database records of 1129 male, US service members who experienced blast-related injuries in Iraq from March 2004 to March 2008. Self-rated health was assessed from the routinely administered pre- and post-deployment health assessment questionnaires by the following question, "Overall, how would you rate your health during the past month?" Possible responses were "poor", "fair", "good", "very good", or "excellent." A distinction was made between minor and major negative changes in health (i.e., very good to fair) based on these self-rated health outcomes captured post-injury.
  
  
  RESULTS
  For all personnel, post-injury levels of self-rated health were statistically significantly worse than pre-injury health rating. At 6months post-injury, service members with MTBI were 5 times more likely to report a major negative change in health as compared to members with other mild injuries. This association was independent of age, rank, branch of service, Injury Severity Score, mental health diagnosis prior to injury, and having been referred to a health care professional.
  
  
  CONCLUSIONS
  Blast-related injuries, specifically MTBI, during deployment have negative consequences on service members' perception of health. Future research is needed to improve our understanding of the overall effects of MTBI on health and quality of life.
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, United States. kevin.heltemes@med.navy.mil
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Heltemes
authors.forename: Troy L
authors.initials: TL
authors.lastname: Holbrook
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Macgregor
authors.forename: Michael R
authors.initials: MR
authors.lastname: Galarneau
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D001930:Brain Injuries / Q000150:complications* / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D038223:Post-Concussion Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011788:Quality of Life; D057566:Self Report; D014481:United States / Q000453:epidemiology; D055815:Young Adult