Project BLAST Balad/Bagram Longitudinal Assessment of the Symptoms of TBI/PTSD/ASD

Disentangling a service member’s physical and psychological wounds following a blast injury – the most common cause of injury for U.S. military personnel deployed in support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) – can be a particularly challenging task. However, an accurate assessment and diagnosis is necessary if the injured service member is to receive the proper care.

That is why, with Defense Department funding through the Military Operational Medicine Research Program, Project BLAST has brought together a multidisciplinary team of military and civilian experts to develop and evaluate a clinical assessment battery that can be used with blast-injury patients in theater – a task that begins with a retrospective review of data collected following previous blast injuries.

That team is led by co-principal investigators Lt Col Monty Baker, PhD, of Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, and Lt Col (Ret) Alan Peterson, PhD, of the University of Texas Health Science Center at San Antonio. Dr. Peterson also serves as director of the STRONG STAR PTSD Research Consortium and has pulled in other STRONG STAR experts and resources to advance this vital effort.

Where it all started

Lt Col Baker, an active-duty Air Force psychologist, knows from first-hand clinical experience that blast injuries can result in physical trauma, such as traumatic brain injury (TBI), as well as psychological trauma, such as posttraumatic stress disorder (PTSD) and its predecessor, acute stress disorder (ASD). Moreover, accurate diagnosis of these conditions can be difficult because, although some of their symptoms are distinct, many overlap. Further complicating the issue is the fact that when an individual’s TBI is mild, resulting neurological impairment may not be readily apparent through routine medical evaluations and brain scans.

These were issues Lt Col Baker faced during his own deployment to Iraq, when he was charged with evaluating more than 750 military blast-injury patients who were sent to the combat theater hospital at which he served. To help with his diagnoses, he compiled a battery of assessments to measure TBI as well as related psychological problems, particularly ASD and PTSD. In the processes, he collected what is believed to be the largest clinical data set that exists on TBI and ASD/PTSD assessed during a military deployment after a blast injury.

Experts on a mission

Now that data will be used by Project BLAST’s panel of experts on TBI, PTSD, ASD, psychometrics, and biostatistics, who will try to “make sense of the data” and use it to develop a standardized assessment battery to recommend to the military. Such a development will make things easier for people who have Lt Col Baker’s former job in the future – ultimately, for the benefit of our combat-injured men and women in uniform.

A three-phase approach

Phase I of Project BLAST entails a retrospective data analysis: Together, investigators will look at the data and ask such questions as, “How do these conditions overlap? What do they have in common? What’s different about them? Can we disentangle them and determine the accurate diagnosis for an individual patient?” Once that work is done, they will ask another set of questions: “Did the battery we examined include the best measures, or all the measures necessary, for this type of assessment? What else is there that might helpful? What set of measures would we recommend that others use?” Answers to these questions will lead to the development of what Project BLAST investigators believe should be the military’s standard assessment battery for TBI, ASD, and PTSD.

When Phase I is complete, it’s on to Phase II: conducting a prospective evaluation of this assessment battery in theater, at military medical treatment facilities in Afghanistan. Military personnel who have suffered a blast injury in Afghanistan and are referred to the study will be assessed with Project BLAST’s recommended measures. An entire new set of complete, standardized data will be collected, from these evaluations, and that data will be used to help evaluate the assessment battery’s efficacy.

Finally, in Phase III, investigators will follow up with volunteer study participants and conduct a reassessment of their physical and psychological health six months later. If they had ASD, did they get better, or did it develop into PTSD? Did those who had a TBI develop post-concussive syndrome, or did they improve?

Benefit to the military

Once all three phases are complete, Project BLAST investigators will be able to recommend to the military a standardized, comprehensive assessment battery for TBI, ASD, and PTSD. This valuable tool should increase the accuracy of complicated diagnoses and lead to the best course of treatment and the improved physical and psychological health of injured warfighters.