Blast-related traumatic brain injury in U.S. military personnel.

摘要

to the editor: The journey by Mac Donald et al. into the statistical intricacies of DTI raises important questions with respect to scientific and clinical clarity. How did the investigators select the 122 service members for the initial screening from approximately 7000 who were medically evacuated to Landstuhl during the study year? If 63 subjects all had "uncomplicated" concussions, why were they evacuated in the first place, and in what way are they representative of the tens of thousands of service members who have deploy-ment-related concussions who remain in theater? Were there clinical differences between those with concussion and the control subjects in terms of the severity of their injuries (e.g., hemorrhagic shock) or among the subjects with concussion (e.g., loss of consciousness) that might explain the presence of DTI abnormalities that exceeded those "expected by chance"? Most importantly, without the inclusion of a comparison group of service members who had deployment-related concussions due to non-blast-related injuries (e.g., falls or accidents), and notwithstanding speculation concerning susceptible brain regions, this study does not appear to be about the effects of blast.