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Abstract Details

Clinical Profiles of Concussed U.S. Soldiers Injured During the January 8th, 2020 Iranian Theatre Ballistic Missile Attack on Al Asad Air Base, Iraq: A Real World, Chaotic, Blast-related TBI Mass Causality Event
Neuro Trauma and Critical Care
P10 - Poster Session 10 (8:00 AM-9:00 AM)

Blast-related TBI is a signature injury from the U.S. con?icts in Iraq and Afghanistan. These have originated from ‘homemade’ improvised explosive devices carrying explosive payloads ranging from 1-5 pounds (e.g. small packages) to 4000 pounds (e.g. Van/SUV/Pick-up truck). The U.S. Military uses the Military Acute Concussion Evaluation 2 as its standard concussion screening tool.

On 2020-01-08, Iran launched 27 professionally manufactured TBMs into Iraq. Eleven, believed to be carrying 1100 to 1650-pound payloads each, detonated within Al Asad Air Base exposing approximately 330 individuals to TBM-blast waves. Clinical pro?les for patients concussed speci?cally from TBM- blast waves, an extremely rare occurrence in modern warfare, have not been described.

To investigate clinical characteristics of theatre ballistic missile (TBM) blast-related concussion.

IRB-approved case series from the Al Asad TBM-blast exposed cohort who medevacked to Landstuhl Regional Medical Center, Germany (LRMC) and were formally diagnosed with concussion by a LRMC Neurologist/TBI medical provider.

Around 4 weeks, TBM-blast exposed individuals still present on Al Asad were screened with the Neurobehavioral Symptom Inventory and Vestibular Ocular-Motor Screening (VOMS); positive screens were medevacked to LRMC. Data from 2020-01-08 to 2020-04-07 was (cross-sectionally) analyzed.

35/38 patients met criteria for mild TBI/concussion (zero for moderate/severe). 34/35 were within a 100-meter blast radius (35/35 within 150-meters). Migraine/headache sub-type was most prominent; 27/31 (87.1%). VOMS was abnormal in 18/18 (100%); 16 deferred due to overt symptoms. MACE-2 cognitive results were abnormal (≤25) in 16/32 (50%). PTSD screens were positive in 13/32 (40.6%). Our ‘4-week screen’ identified nine additional concussed individuals.

Among TBM-blast concussion patients, migraine/headache was the predominant clinical sub-type. Vestibular, cognitive, and mood/anxiety sub-types were also common. Our study supports post-concussion screening which includes both a subjective symptom inventory and an objective, performance-based ocular-motor/vestibular screening exam (e.g. VOMS) to help identify patients who may under recognize or underreport/minimize symptoms.

Jeffrey B. Hainsworth, DO (Emerson Health Neurology)
Dr. Hainsworth has stock in Amgen Inc. Dr. Hainsworth has stock in Bristol Myers Squibb Company. Dr. Hainsworth has stock in Johnson & Johnson. Dr. Hainsworth has stock in Medtronic PLC. Dr. Hainsworth has stock in Merck. Dr. Hainsworth has stock in Stryker Corp. Dr. Hainsworth has stock in ABBV.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file