Cumulative Blast Impulse Is Predictive for Changes in Chronic Neurobehavioral Symptoms Following Low Level Blast Exposure during Military Training

Author:

McEvoy Cory12,Crabtree Adam1,Case John1,Means Gary E1,Muench Peter1,Thomas Ronald G3,Ivory Rebecca A45,Mihalik Jason6,Meabon James S78ORCID

Affiliation:

1. United States Army Special Operations Command , Fort Liberty, NC 28310, USA

2. CU Anschutz Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine , Aurora, CO 80045, USA

3. Division of Biostatistics, Department of Family Medicine & Public Health, University of California San Diego , La Jolla, CA 92093, USA

4. University of Washington School of Nursing , Seattle, WA 98195, USA

5. University of Delaware School of Nursing , Newark, DE 19713, USA

6. Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina , Chapel Hill, NC 27599, USA

7. Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System , Seattle, WA 98108, USA

8. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, WA 98259, USA

Abstract

ABSTRACT Introduction Cumulative low-level blast exposure during military training may be a significant occupational hazard, increasing the risk of poor long-term outcomes in brain function. US Public Law 116-92 section 717 mandates that US Department of Defense agencies document the blast exposure of each Service member to help inform later disability and health care decisions. However, which empirical measures of training blast exposure, such as the number of incidents, peak overpressure, or impulse, best inform changes in the neurobehavioral symptoms reflecting brain health have not been established. Materials and Methods This study was approved by the US Army Special Operations Command, the University of North Carolina at Chapel Hill, and the VA Puget Sound Health Care System. Using methods easily deployable across different organizational structures, this study sought to identify and measure candidate risk factors related to career occupational blast exposure predictive of changes in neurobehavioral symptom burden. Blast dosimetry-symptom relationships were first evaluated in mice and then tested in a military training environment. In mice, the righting time neurobehavioral response was measured after exposure to a repetitive low-level blast paradigm modeled after Special Operations training. In the military training environment, 23 trainees enrolled in a 6-week explosive breaching training course, 13 instructors, and 10 Service member controls without blast exposure participated in the study (46 total). All participants provided weekly Neurobehavioral Symptom Inventory (NSI) surveys. Peak blast overpressure, impulse, total number of blasts, Time in Low-Level Blast Occupation, and Time in Service were analyzed by Bayesian analysis of regression modeling to determine their probability of influence on the post-training symptoms reported by participants. Results We tested the hypothesis that cumulative measures of low-level blast exposure were predictive of changes in neurobehavioral symptoms. In mice, repetitive blast resulted in reduced righting times correlated with cumulative blast impulse. In Service members, peak blast overpressure, impulse, total number of blasts, Time in Low-Level Blast Occupation, and Time in Service all showed strong evidence of influence on NSI scores after blast exposure. However, only models including baseline NSI scores and cumulative blast impulse provided significant predictive value following validation. Conclusions These results indicate that measures of cumulative blast impulse may have utility in predicting changes in NSI scores. Such paired dosimetry-symptom measures are expected to be an important tool in safely guiding Service members’ occupational exposure and optimizing force readiness and lethality.

Funder

Biomedical Laboratory Research and Development, VA Office of Research and Development

Congressionally Directed Medical Research Programs

Publisher

Oxford University Press (OUP)

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