Relationship between clinician documented blast exposure and pulmonary function: a retrospective chart review from a national specialty clinic.
Relationship between clinician documented blast exposure and pulmonary function: a retrospective chart review from a national specialty clinic.
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DOI：
10.1186/s12931-022-02071-0
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发表时间：
2022-06-10
影响因子：
5.8
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中科院分区：
文献类型：
--
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服役人员暴露在爆炸性爆炸超压波中是很常见的，并相当关注创伤性脑损伤(TBI)和神经心理后遗症。尽管容易受到超压，但对呼吸系统的影响，特别是长期影响，人们知之甚少。使用国家登记，我们以前观察到自我报告的冲击波暴露和呼吸道症状之间的独立关系；然而，对肺功能的客观测量的影响知之甚少。307名退伍军人被转介到我们的国家专业中心进行部署后健康问题的综合多天评估，其中包括完整的肺功能测试(PFT)、职业和环境医学史、神经心理或心理评估。我们开发了一种先验图表提取过程和模板来将退伍军人分为：(1)无暴露组，(2)单一轻度暴露组，(3)多轻度暴露组。该模板主要集中在临床医生记录的与冲击波相关的颅脑损伤，作为胸部冲击波超压损伤的替代。选择表征血流(FEV1%；%∆FEV1)、容量(TLC%)、弥散(DLco%)和呼吸力学(强迫振荡法)的PFT变量进行分析。退伍军人(40.5 ± 9.7岁；16.3%女性)在最后一次部署后5年转诊至8.6 ± 3.6岁，并出现相当多的并存状况和健康问题(例如，62%的创伤后应激障碍，55%的呼吸困难)。在提取图表后，退伍军人被分配到无(n = 208)、单一轻度(n = 52)和多次轻度(n = 47)冲击波暴露组。在暴露的爆炸中，临床医生记录的73.7%是距离爆炸50米的 <； ，40.4%的人被爆炸移动。所有组的PFT结果测量结果相似(p值范围：0.10-0.99)。在这份已部署退伍军人的参考样本中，根据应用的回顾图表提取方法，流量、容量、扩散和呼吸力学的PFT测量与临床医生记录的冲击波暴露无关。然而，这些临床发现表明，未来的研究应该确定和评估老兵对爆炸经历的记忆与呼吸系统超压波暴露之间的区别。网上版载有补充材料，可在10.1186/s12931-022-02071-0查阅。
Service member exposure to explosive blast overpressure waves is common with considerable attention to traumatic brain injury (TBI) and neuropsychological sequalae. Less is known about the impacts on the respiratory system, particularly long-term effects, despite vulnerability to overpressure. Using a national registry, we previously observed an independent relationship between self-reported blast exposure and respiratory symptoms; however, the impact on objective measures of pulmonary function is poorly understood. 307 Veterans referred to our national specialty center for post-deployment health concerns underwent a comprehensive multi-day evaluation that included complete pulmonary function testing (PFT), occupational and environmental medicine history, neuropsychological or psychological evaluation. We developed an a priori chart abstraction process and template to classify Veterans into blast exposure groups: (1) none, (2) single-mild, or (3) multiple-mild. This template focused primarily on clinician documented notes of blast related TBI that were used as proxy for blast overpressure injury to thorax. PFT variables characterizing flow (FEV1%; %∆FEV1), volume (TLC%), diffusion (DLCO%) and respiratory mechanics (forced oscillometry) were selected for analysis. Veterans (40.5 ± 9.7 years; 16.3% female) were referred 8.6 ± 3.6 years after their last deployment and presented with considerable comorbid conditions and health problems (e.g., 62% post-traumatic stress, 55% dyspnea). After chart abstraction, Veterans were assigned to none (n = 208), single mild (n = 52) and multiple mild (n = 47) blast exposure groups. Among the blast exposed, clinicians documented 73.7% were < 50 m from the blast and 40.4% were physically moved by blast. PFT outcome measures were similar across all groups (p value range: 0.10–0.99). In this referred sample of deployed Veterans, PFT measures of flow, volume, diffusion, and respiratory mechanics were not associated with clinician documented blast exposure per the retrospective chart abstraction methodology applied. Yet, these clinical findings suggest future research should determine and assess distinction between Veteran recollections of perceived blast experiences versus overpressure wave exposure to the respiratory system. The online version contains supplementary material available at 10.1186/s12931-022-02071-0.
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