Assessment of Blood Biomarker Profile After Acute Concussion During Combative Training Among US Military Cadets: A Prospective Study From the NCAA and US Department of Defense CARE Consortium.

Importance: Validation of protein biomarkers for concussion diagnosis and management in military combative training is important, as these injuries occur outside of traditional health care settings and are generally difficult to diagnose. Objective: To investigate acute blood protein levels in military cadets after combative training-associated concussions. Design, Setting, and Participants: This multicenter prospective case-control study was part of a larger cohort study conducted by the National Collegiate Athletic Association and the US Department of Defense Concussion Assessment Research and Education (CARE) Consortium from February 20, 2015, to May 31, 2018. The study was performed among cadets from 2 CARE Consortium Advanced Research Core sites: the US Military Academy at West Point and the US Air Force Academy. Cadets who incurred concussions during combative training (concussion group) were compared with cadets who participated in the same combative training exercises but did not incur concussions (contact-control group). Clinical measures and blood sample collection occurred at baseline, the acute postinjury point (<6 hours), the 24- to 48-hour postinjury point, the asymptomatic postinjury point (defined as the point at which the cadet reported being asymptomatic and began the return-to-activity protocol), and 7 days after return to activity. Biomarker levels and estimated mean differences in biomarker levels were natural log (ln) transformed to decrease the skewness of their distributions. Data were collected from August 1, 2016, to May 31, 2018, and analyses were conducted from March 1, 2019, to January 14, 2020. Exposure: Concussion incurred during combative training. Main Outcomes and Measures: Proteins examined included glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1, neurofilament light chain, and tau. Quantification was conducted using a multiplex assay (Simoa; Quanterix Corp). Clinical measures included the Sport Concussion Assessment Tool-Third Edition symptom severity evaluation, the Standardized Assessment of Concussion, the Balance Error Scoring System, and the 18-item Brief Symptom Inventory. Results: Among 103 military service academy cadets, 67 cadets incurred concussions during combative training, and 36 matched cadets who engaged in the same training exercises did not incur concussions. The mean (SD) age of cadets in the concussion group was 18.6 (1.3) years, and 40 cadets (59.7%) were male. The mean (SD) age of matched cadets in the contact-control group was 19.5 (1.3) years, and 25 cadets (69.4%) were male. Compared with cadets in the contact-control group, those in the concussion group had significant increases in glial fibrillary acidic protein (mean difference in ln values, 0.34; 95% CI, 0.18-0.50; P < .001) and ubiquitin C-terminal hydrolase-L1 (mean difference in ln values, 0.97; 95% CI, 0.44-1.50; P < .001) levels at the acute postinjury point. The glial fibrillary acidic protein level remained high in the concussion group compared with the contact-control group at the 24- to 48-hour postinjury point (mean difference in ln values, 0.22; 95% CI, 0.06-0.38; P = .007) and the asymptomatic postinjury point (mean difference in ln values, 0.21; 95% CI, 0.05-0.36; P = .01). The area under the curve for all biomarkers combined, which was used to differentiate cadets in the concussion and contact-control groups, was 0.80 (95% CI, 0.68-0.93; P < .001) at the acute postinjury point. Conclusions and Relevance: This study's findings indicate that blood biomarkers have potential for use as research tools to better understand the pathobiological changes associated with concussion and to assist with injury identification and recovery from combative training-associated concussions among military service academy cadets. These results extend the previous findings of studies of collegiate athletes with sport-associated concussions.

Mild traumatic brain injuries with loss of consciousness are associated with increased inflammation and pain in military personnel.

Mild traumatic brain injuries (mTBI) are a pervasive concern for military personnel. Determining the impact of injury severity, including loss of consciousness (LOC) may provide important insights into the risk of psychological symptoms and inflammation commonly witnessed in military personnel and veterans following mTBI. US military personnel and veterans were categorized into three groups; TBI with LOC (n = 36), TBI without LOC (n = 25), Controls (n = 82). Participants reported their history of mTBI, psychological symptoms (post-traumatic stress disorder [PTSD] and depression), health-related quality of life (HRQOL), and underwent a blood draw. ANCOVA models which controlled for insomnia status and combat exposure indicated that both mTBI groups (with/without LOC) reported significantly greater depression and PTSD symptoms compared to controls; however, they did not differ from each other. The mTBI with LOC did report greater pain than both controls and mTBI without LOC. The TBI with LOC group also had significantly elevated IL-6 concentrations than both TBI without LOC and control groups. Within the mTBI groups, increased TNFα concentrations were associated with greater PTSD symptoms. These findings indicate that sustaining an mTBI, with or without LOC is detrimental for psychological wellbeing. However, LOC may be involved in perceptions of pain and concentrations of IL-6.

Accidente laboral en alumnos del internado rotatorio de la carrera de medicina de la UNNE / Occupational accident to students Rotating Internship Career UNNE Medicine

Resumen La exposición a material biológico es el más frecuente de los riesgos que corren los trabajadores de la salud, y enconsecuencia los estudiantes del internado rotatorio. El presente estudio propone el análisis de las características de los accidentes producidos por contacto con material biológico en alumnos del Internado Rotatorio de la carrera de Medicina de la Facultad de Medicina de la UNNE.Estudio descriptivo retrospectivo de corte transversal en base a las declaraciones de los alumnos que sufrieron exposición accidental a sangre y fluidos. De 400 cursantes, 25 denunciaron accidente laboral. Con mayor frecuencia se produjeron en Servicios de Emergencias, lesiones de tipo punzocortantes y contacto con sangre. Como medida de bioseguridad exclusiva se utilizaron guantes. La mayor parte de los encuestados desconocía las pautas postexposición. La mayoría de los estudiantes notificó el hecho, pero gran parte no tomó medidas al respecto. La toma de muestras para serología fue mínima, y el porcentaje de estudiantes que recibió tratamiento quimioprofiláctico post exposición fue aún menor. Por todo ello creemos fundamental insistir con diferentes estrategias en la concientización a los alumnos,jerarquizando la prevención y las pautas a seguir en caso de producirse el accidente.

Summary Exposure to biological material is the most frequent risk for the health workers, and the rotating internship studentstoo. This study proposes the review of characteristics of accidents caused by contact with biological material in studentscoursing what we call “Internado Rotatorio” at the UNNE School of Medicine.Retrospective descriptive study of cross-section based on statements by students who suffered accidental exposureto blood and other fluids.Among 400 students, 25 reported work- accidents. This event happened most frequently in Emergency Services, bysharp and contact with blood-like lesions. They used gloves as the exclusive biosecurity measure. Most of the studentsreported the fact, but not all of them took any action in this regard. Sampling for serology was minimal, and thepercentage of students receiving prophylaxis post exposure treatment was even lower. Because of this, we believe essentialto insist with different strategies awareness to students, structuring prevention and guidelines to be followedin case of this kind of accident.

La exposição a material biológico é o mais frequente dos riscos para dos trabalhadores da saúde estão expostos e, portanto,os alunos de estágio rotativo. O presente estudo propõe uma análise das características dos acidentes causadospor contato com material biológico em alunos do internato rotativo da Carreira Médica da faculdade de Medicinada UNNE.Estudo descritivo retrospectivo de secção baseado em declarações de estudantes que sofreram exposição acidentala sangue e fluidos. De 400 alunos, 25 relatou acidentes relacionados com o trabalho. Com mais freqüência ocorreuem serviços de emergência, afiada e contato com sangue, como lesões. Luvas foram usadas como medida de biossegurançaexclusiva. A maioria dos entrevistados sabem padrões pós-exposição. A maior parte dos estudantes relatouo fato, mas não tomaram nenhuma medida nenhuma ação quanto a isso. Amostragem de serologia era mínima, e apercentagem de alunos recebem tratamento de exposição do quimioprofiláctico post foi ainda menor.É por isso que consideramos essenciais para insistir com consciência de estratégias diferentes para estudantes, estruturaçãode prevenção e orientações a seguir em caso de acidente.

Accidente laboral en alumnos del internado rotatorio de la carrera de medicina de la UNNE / Occupational accident to students Rotating Internship Career UNNE Medicine

Resumen La exposición a material biológico es el más frecuente de los riesgos que corren los trabajadores de la salud, y enconsecuencia los estudiantes del internado rotatorio. El presente estudio propone el análisis de las características de los accidentes producidos por contacto con material biológico en alumnos del Internado Rotatorio de la carrera de Medicina de la Facultad de Medicina de la UNNE.Estudio descriptivo retrospectivo de corte transversal en base a las declaraciones de los alumnos que sufrieron exposición accidental a sangre y fluidos. De 400 cursantes, 25 denunciaron accidente laboral. Con mayor frecuencia se produjeron en Servicios de Emergencias, lesiones de tipo punzocortantes y contacto con sangre. Como medida de bioseguridad exclusiva se utilizaron guantes. La mayor parte de los encuestados desconocía las pautas postexposición. La mayoría de los estudiantes notificó el hecho, pero gran parte no tomó medidas al respecto. La toma de muestras para serología fue mínima, y el porcentaje de estudiantes que recibió tratamiento quimioprofiláctico post exposición fue aún menor. Por todo ello creemos fundamental insistir con diferentes estrategias en la concientización a los alumnos,jerarquizando la prevención y las pautas a seguir en caso de producirse el accidente. (AU)

Summary Exposure to biological material is the most frequent risk for the health workers, and the rotating internship studentstoo. This study proposes the review of characteristics of accidents caused by contact with biological material in studentscoursing what we call ôInternado Rotatorioö at the UNNE School of Medicine.Retrospective descriptive study of cross-section based on statements by students who suffered accidental exposureto blood and other fluids.Among 400 students, 25 reported work- accidents. This event happened most frequently in Emergency Services, bysharp and contact with blood-like lesions. They used gloves as the exclusive biosecurity measure. Most of the studentsreported the fact, but not all of them took any action in this regard. Sampling for serology was minimal, and thepercentage of students receiving prophylaxis post exposure treatment was even lower. Because of this, we believe essentialto insist with different strategies awareness to students, structuring prevention and guidelines to be followedin case of this kind of accident. (AU)

La exposiþÒo a material biológico é o mais frequente dos riscos para dos trabalhadores da saúde estÒo expostos e, portanto,os alunos de estágio rotativo. O presente estudo prop§e uma análise das características dos acidentes causadospor contato com material biológico em alunos do internato rotativo da Carreira Médica da faculdade de Medicinada UNNE.Estudo descritivo retrospectivo de secþÒo baseado em declaraþ§es de estudantes que sofreram exposiþÒo acidentala sangue e fluidos. De 400 alunos, 25 relatou acidentes relacionados com o trabalho. Com mais freq³Ûncia ocorreuem serviþos de emergÛncia, afiada e contato com sangue, como les§es. Luvas foram usadas como medida de biosseguranþaexclusiva. A maioria dos entrevistados sabem padr§es pós-exposiþÒo. A maior parte dos estudantes relatouo fato, mas nÒo tomaram nenhuma medida nenhuma aþÒo quanto a isso. Amostragem de serologia era mínima, e apercentagem de alunos recebem tratamento de exposiþÒo do quimioprofiláctico post foi ainda menor.E por isso que consideramos essenciais para insistir com consciÛncia de estratégias diferentes para estudantes, estruturaþÒode prevenþÒo e orientaþ§es a seguir em caso de acidente. (AU)