Combat blast injuries are typically categorized by the mechanism of injury. Primary blast injuries result from the over-pressurization wave and typically affect gas-filled body structures (eg, lungs, gastrointestinal tract, middle ear) resulting in injuries such as blast lung, tympanic membrane rupture, abdominal hemorrhage, and concussion. Secondary blast injuries result from flying debris propelled by the blast wind and may affect any body part. Blunt force or penetrating injuries are possible. Tertiary blast injuries occur when the body is accelerated by the blast wind or pressure gradients. Any body part may be affected and typical injuries include fracture and traumatic amputation, closed and open brain injuries, and crush injuries. Quaternary blast injuries are due to other products of the explosion (eg, heat, light) and exposure to toxins and gases. Any body part may be affected and injuries include burns, blindness, and respiratory problems from inhaled toxic gases. Quinary blast injuries include illnesses, injuries, and diseases resulting from post-explosion environmental contaminants (eg, bacteria, radiation).
Despite recognition of greater use of improvised and other explosive devices in the Afghanistan and Iraq War counter-insurgency operations relative to prior conflicts, the scientific literature regarding the incidence and prevalence of explosive device-induced injuries is limited. Additionally, the consequences of experiencing a traumatic brain injury (TBI) related to blast exposure versus a TBI due to other mechanisms of injury may be different. Accurate assessment of the incidence and prevalence of blast- and non-blast-related injuries as well as their long-term outcomes is a critical first step in injury prevention, treatment, and health system resource management. The purpose of this report is to systematically review the literature on 1) incidence and prevalence of combat blast injuries sustained during Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) 2001 through 2014 and 2) the outcomes (eg, pain, vision loss, cognitive function, quality of life) following blast versus non-blast TBI.
We developed the following Key Questions with input from stakeholders and Technical Expert Panel (TEP) members:
Key Question 1: What is the incidence of combat blast injuries associated with OEF, OIF, and OND as reported in the literature or in published reports from Department of Defense (DoD) and VA databases during the period 2001-2014?
Key Question 1a: What is the incidence by blast characteristics (ie, primary, secondary, tertiary, quaternary, and quinary), injury site, and injury outcome?
Key Question 2: What is the prevalence of combat blast injuries associated with OEF, OIF, and OND as reported in the literature or in published reports from Department of Defense (DoD) and VA databases during the period 2001-2014?
Key Question 2a: What is the prevalence of blast injury by blast characteristics, injury site, and injury outcome?
Key Question 3: What are the short-term (up to 30 days), mid-term (30 days to one year) and long-term (greater than one year) injury outcomes (ie, pain, burns, limb loss, vision loss, hearing loss, vestibular dysfunction, mental health/PTSD, cognitive function, quality of life, functional status/employment, other-organ system-specific) among US military personnel (2001-2014) who have sustained a blast-related TBI versus a non-blast TBI or a combined blast/non-blast TBI?
Key Question 3a: What are the short-term (up to 30 days), mid-term (30 days to one year) and long-term (greater than one year) injury outcomes among US military personnel (2001-2014) who have sustained a blast-related TBI according to blast characteristics?
Greer N, Sayer N, Koeller E, Velasquez T, Wilt T. Outcomes Associated with Blast versus Nonblast-related Traumatic Brain Injury in US Military Service Members and Veterans: A Systematic Review. Journal of Head Trauma Rehabilitation. Published online 04/20/17. DOI: 10.1097/HTR.0000000000000304.
In June 2017, the Department of Defense Blast Injury Research Program's Coordinating Office featured the article on combat blast injuries based on the Minneapolis ESP Center's 2015 report. The US Army Medical Research and Materiel Command's Facebook page also highlighted the article.