Initial Mild Traumatic Brain Injury Characteristics and Recovery Patterns Among Females Across the United States Military Service Academies: A Report from the NCAA-DoD CARE Consortium

Landon B. Lempke*, Elsa Ermer, Adrian J. Boltz, Jaclyn Caccese, Thomas A. Buckley, Kenneth L. Cameron, Sara P.D. Chrisman, Christopher D’Lauro, James T. Eckner, Carrie Esopenko, Tamerah N. Hunt, Divya Jain, Louise A. Kelly, Allyssa K. Memmini, Anne E. Mozel, Margot Putukian, Adam Susmarski, Paul F. Pasquina, Michael A. McCrea, Thomas W. McAllisterSteven P. Broglio, Christina L. Master

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Mild traumatic brain injury (mTBI) has been described in the United States (US) military service academy cadet population, but female-specific characteristics and recovery outcomes are poorly characterized despite sex being a confounder. Our objective was to describe female cadets’ initial characteristics, assessment performance, and return-to-activity outcomes post-mTBI. Female cadets (n = 472) from the four US military service academies who experienced a mTBI completed standardized mTBI assessments from pre-injury to acute initial injury and unrestricted return-to-duty (uRTD). Initial injury presentation characteristics (e.g., delayed symptoms, retrograde amnesia) and return-to-activity outcomes [i.e., return-to-learn, initiate return-to-duty protocol (iRTD), uRTD] were documented. Descriptive statistics summarized female cadets’ injury characteristics, return-to-activity outcomes, and post-mTBI assessment performance change categorization (worsened, unchanged, improved) relative to pre-injury baseline using established change score confidence rank criteria for each assessment score. The median (interquartile range) days to return-to-learn (n = 157) was 7.0 (3.0–14.0), to iRTD (n = 412) was 14.7 (8.6–25.8), and to uRTD (n = 431) was 26.0 (17.7–41.8). The majority experienced worse SCAT total symptom severity (77.8%) and ImPACT reaction time (97.0%) acutely < 24-h versus baseline, but unchanged BESS total errors (75.2%), SAC total score (72%), BSI-18 total score (69.6%), and ImPACT verbal memory (62.3%), visual memory (58.4%), and visual motor speed (52.5%). We observed similar return-to-activity times in the present female cadet cohort relative to the existing female-specific literature. Confidence ranks categorizing post-mTBI performance were heterogenous and indicate multimodal assessments are necessary. Our findings provide clinically relevant insights to female cadets experiencing mTBI across the US service academies for stakeholders providing healthcare.

Original languageEnglish
JournalAnnals of Biomedical Engineering
DOIs
StateAccepted/In press - 2023
Externally publishedYes

Keywords

  • Active duty
  • Concussion
  • Psychological
  • Recovery
  • Veteran

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