Research letter: Retrograde amnesia and posttraumatic amnesia in service members and Veterans with remote history of traumatic brain injury

Abstract: Objective: The recently updated American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury (mTBI) removed retrograde amnesia (RA) as a main criterion for mTBI, recommending it be included as a substitute criterion only when posttraumatic amnesia (PTA) cannot be reliably assessed. This study aimed to investigate the evidence base for this recommendation. Setting: Military treatment facility. Participants: A total of 752 US military service members/veterans (mean age = 36.1 years, SD = 9.4 years) with a history of TBI prospectively enrolled in the Defense and Veterans Brain Injury Center-Traumatic Brain Injury Center of Excellence 15-Year Longitudinal TBI study who sustained a total of 1015 TBIs with substantiated RA and PTA. Most participants were male (93.6%), not of Hispanic Origin (84.7%), and White (84.5%). Evaluations were conducted on average 7.6 years (SD = 6.9 years) after injury. Design: Case series. Main measures: Presence and duration of RA and PTA; and ratio of PTA and RA (PTA:RA). Results: There were no TBIs where RA was present but PTA was absent. Within the 1015 TBIs, 896 (88.3%) involved both RA and PTA, 65 (6.4%) involved PTA only, and 54 (5.3%) did not involve RA or PTA. For the 635 TBI events with substantiated recorded minutes of RA and PTA both >0, the mean ratio of PTA:RA was 31:1. In only one instance was the ratio of PTA:RA <1. Conclusion: There were no TBIs where RA was present without PTA. RA tended to be much shorter than PTA. Findings support the American Congress of Rehabilitation Medicine's decision to remove RA as a main criterion for mTBI.

Read the full article
Report a problem with this article

Related articles

  • More for Researchers

    Qualitative analysis of the lived experience of reproductive and pediatric health care in the military health care system

    Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.