Self-reported injuries and neurological symptoms among military veterans of Iraq and Afghanistan: Associations between injury mechanism, immediate post-injury symptoms, and persistent symptoms

Purpose: This study assessed injury experience in combat theaters among veterans with service in Iraq/Afghanistan sometime during September 2001 - September 2004, together with their immediate post-injury symptoms and persistent neuropsychological symptoms. Methods: In 2005, an anonymous survey was mailed to veterans residing in the Mid-Atlantic (n=7259). Results: Respondents (n=2235; 31% participation) resembled the veteran population with regard to gender (86% male), but ages 41-65 were overrepresented while those 18-25 were underrepresented. Blasts were the third most frequently reported cause of injury following physical training/sports and falls. Blasts were associated with the highest risk ratios (RR) for persistent symptoms that resemble Post-Concussion Syndrome (PCS): e.g. ringing in the ears (RR=8.1, 95% confidence interval (CI)=5.9, 11.1) and headache (RR= 7.7, CI=5.0, 11.9). Falls, motor vehicle injuries, and sport injuries also were associated with chronic symptoms. Immediate post-injury symptoms are strongly associated with persistent neurological symptoms similar to PCS. For example, being “dazed and confused” post-injury is strongly associated with elevated risks for irritability (RR=6.9, CI=5.1, 9.3) and memory problems (RR= 7.4, CI=5.3, 10.3). Self-reported loss of consciousness <1 minute is associated with increases in: sleep problems (RR=7.3, CI=5.5, 9.8); irritability (RR= 7.1, CI=4.6, 11.0); and headaches (RR=10.9, CI=6.6, 17.9). Conclusions: Veterans of wars in Iraq/Afghanistan are at high risk of injury. These data suggest that symptoms immediately following an injury are markers for development of persistent symptoms. Incidence of head injuries may be undercounted because few respondents reporting concussion-like symptoms have been told by a clinician they received a head injury.