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Outcomes Associated With Blast Versus Nonblast-Related Traumatic Brain Injury in US Military Service Members and Veterans

A Systematic Review

Greer, Nancy PhD; Sayer, Nina PhD; Koeller, Eva BA; Velasquez, Tina MS; Wilt, Timothy J. MD, MPH

The Journal of Head Trauma Rehabilitation: March/April 2018 - Volume 33 - Issue 2 - p E16–E29
doi: 10.1097/HTR.0000000000000304
TBI in the Military 2018

Objectives: To systematically review the literature on comparative clinical and functional outcomes following blast-related versus nonblast-related traumatic brain injury (TBI) among US service members and Veterans.

Design: MEDLINE search (January 2001 to June 2016) supplemented with hand search of reference lists and input from peer reviewers.

Results: Thirty-one studies (in 33 articles) reported on health outcomes; only 2 were rated low risk of bias. There was variation in outcomes reported and methods of assessment. Blast and nonblast TBI groups had similar rates of depression, sleep disorders, alcohol misuse, vision loss, vestibular dysfunction, and functional status. Comparative outcomes were inconsistent with regard to posttraumatic stress disorder diagnosis or symptoms, headache, hearing loss, and neurocognitive function. Mortality, burn, limb loss, and quality of life were each reported in few studies, most with small sample sizes. Only 4 studies reported outcomes by blast injury mechanism.

Conclusions: Most clinical and functional outcomes appeared comparable in military service members and Veterans with TBI, regardless of blast exposure. Inconsistent findings and limited outcomes reporting indicate that more research is needed to determine whether there is a distinct pattern of impairments and comorbidities associated with blast-related TBI.

Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minnesota, Minneapolis (Drs Greer, Sayer, and Wilt and Mss Koeller and Velasquez); and Departments of Medicine and Psychiatry (Dr Sayer) and School of Medicine (Dr Wilt), University of Minnesota, Minneapolis.

Corresponding Author: Nancy Greer, PhD, Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, 1 Veterans Dr, Mail Code 111-O, Minneapolis, MN 55417 (

The full evidence report was funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

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