Injury Correlates of Acute Stress Disorder Following Combat Injury

INTRODUCTION: Acute stress disorder (ASD) can impair combatants' short-term functioning and delay return-to-duty. This study's objective was to analyze patient- and injury-specific correlates of ASD following combat injury. MATERIALS AND METHODS: This was a retrospective analysis of existing health data for 1,394 service members who sustained combat injuries in Operations Iraqi and Enduring Freedom and completed items on traumatic experiences on the post-deployment health assessment (PDHA). ASD status was defined as screening positive on PDHA items between 4 and 30 days postinjury per established criteria. RESULTS: Most patients (81%) sustained minor injuries caused by blast weaponry. Overall, 24% of patients (336 of 1,394) screened positive for ASD. In multivariable models, preinjury mental health diagnosis and mild traumatic brain injury (TBI) were associated with significantly higher rates of ASD. The prevalence ratio (PR) (95% confidence interval [CI]) of ASD was 1.57, (CI = 1.26-1.68, P < .001 for mild TBI (vs no TBI). ASD also was associated with significantly higher PR for post-traumatic stress disorder during the first year postinjury. CONCLUSIONS: The present findings suggest a significant association between mild TBI and increased likelihood of later ASD following combat injury. The present results inform combat casualty care guidelines to include TBI as a factor to help identify ASD cases for appropriate treatment. The PDHA may provide a method for future research on ASD during the first 30 days following combat trauma.