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Eur J Trauma Emerg Surg 2022 Jun 25. Epub 2022 Jun 25.

Department of Emergency Medicine, American University of Beirut Medical Center, Riad El Solh, P.O.Box-11-0236, Beirut, 1107 2020, Lebanon.

Purpose: To describe injuries and outcomes of casualties of Beirut Port Blast treated at a large tertiary care center in Beirut, Lebanon.

Methods: A retrospective observational study assessing the spectrum of injuries, treatment, and medical outcome among casualties of the Beirut Port Blast, immediately after the blast and up to 1 week from the blast to the emergency department of the American University of Beirut Medical Center (AUBMC).

Results: A total of 359 patients were included. Read More

Transfusion 2022 Jun 22. Epub 2022 Jun 22.

Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Background: Mass casualty incidents (MCIs) create an immediate surge in blood product demand. We hypothesize local inventories in major U.S. Read More

Eur J Trauma Emerg Surg 2022 Jun 21. Epub 2022 Jun 21.

Purpose: To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance.

Methods: UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres.

Results: All 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. Read More

Arch Public Health 2022 Jun 17;80(1):156. Epub 2022 Jun 17.

Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.

Background: On August 4, 2020, Lebanon faced one of the deadliest mass casualty explosions the world has witnessed during the twenty-first century. The human and emotional tolls were heavy on attending physicians, clinical fellows, residents, interns, medical students, and registered nurses, who were working in dramatic conditions, triaging, and treating thousands of blast-related casualties. We evaluated the risk of developing post-traumatic stress disorder symptoms (PTSS), among these healthcare workers (HCWs) from different Lebanese hospitals. Read More

Lancet Psychiatry 2022 07;9(7):547-554

King's Centre for Military Health Research, King's College London, London, UK; Academic Department of Military Mental Health, King's College London, London, UK. Electronic address:

Background: The long-term psychosocial outcomes of UK armed forces personnel who sustained serious combat injuries during deployment to Afghanistan are largely unknown. We aimed to assess rates of probable post-traumatic stress disorder (PTSD), depression, anxiety, and mental health-associated multimorbidity in a representative sample of serving and ex-serving UK military personnel with combat injuries, compared with rates in a matched sample of uninjured personnel.

Methods: This analysis used baseline data from the ADVANCE cohort study, in which injured individuals were recruited from a sample of UK armed forces personnel who were deployed to Afghanistan and had physical combat injuries, according to records provided by the UK Ministry of Defence. Read More

Biophys J 2022 Jun 15. Epub 2022 Jun 15.

Chemical Engineering Department, University of Massachusetts, Amherst, USA.

Nonpenetrating traumatic brain injuries (TBI) are linked to cavitation. The structural organization of the brain makes it particularly susceptible to tears and fractures from these cavitation events, but limitations in existing characterization methods make it difficult to understand the relationship between fracture and cavitation in this tissue. More broadly, fracture energy is an important, yet often overlooked, mechanical property of all soft tissues. Read More

Plast Reconstr Surg Glob Open 2022 Jun 10;10(6):e4372. Epub 2022 Jun 10.

Department of Plastic Surgery, Beaumont Health Systems, Royal Oak, Mich.

Patients with gunshot wounds to the face have massive soft tissue and bony damage from projectile and blast injuries. They often require multiple, staged reconstructive surgeries with cross-facial nerve grafting and free muscle flap for re-establishment of facial expression. Injury to or total loss of the facial nerve and branches can result in loss of function of the orbicularis oculi muscle, which leads to the loss of protective mechanisms of eyelid function and blink reflex. Read More

Respir Res 2022 Jun 10;23(1):153. Epub 2022 Jun 10.

Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07018, USA.

Background: 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. Read More

Br J Anaesth 2022 Jun 7. Epub 2022 Jun 7.

Anaesthetics, Pain Medicine, and Intensive Care Section, Department of Surgery and Cancer, Imperial College London, London, UK; Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, UK. Electronic address:

Background: The noble gases argon and xenon are potential novel neuroprotective treatments for acquired brain injuries. Xenon has already undergone early-stage clinical trials in the treatment of ischaemic brain injuries, with mixed results. Argon has yet to progress to clinical trials as a treatment for brain injury. Read More

Sci Rep 2022 Jun 8;12(1):9490. Epub 2022 Jun 8.

Department of Oral and Maxillofacial Surgery, National Defense Medical College, Tokorozawa, Japan.

Air embolism is generally considered the most common cause of death within 1 h of a blast injury. Shock lung, respiratory arrest, and circulatory failure caused by vagal reflexes contribute to fatal injuries that lead to immediate death; however, informative mechanistic data are insufficient. Here we used a laser-induced shock wave (LISW) to determine the mechanism of acute fatalities associated with blast injuries. Read More

J Spec Oper Med 2022 May;22(2):9-28

The types of injuries seen in combat action on a naval surface ship may be similar in many respects to the injuries seen in ground combat, and the principles of care for those injuries remain in large part the same. However, some contradistinctions in the care of combat casualties on a ship at sea must be highlighted, since this care may entail a number of unique challenges and different wounding patterns. This paper presents a scenario in which a guided missile destroyer is struck by a missile fired from an unmanned aerial vehicle operated by an undetermined hostile entity. Read More

J Neurotrauma 2022 May 27. Epub 2022 May 27.

Icahn School of Medicine at Mount Sinai, 5925, Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, New York, United States, 10029;

Emerging evidence suggests that repeated blast exposure (RBE) is associated with brain injury in military personnel. United States (U.S. Read More

Oxid Med Cell Longev 2022 17;2022:8407635. Epub 2022 May 17.

College of Medicine and Biological Information Engineering, Northeastern University, No. 195, Chuangxin Road, Hunnan District, Shenyang, Liaoning Province 110016, China.

Explosion-induced injury is the most commonly encountered wound in modern warfare and incidents. The vascular inflammatory response and subsequent oxidative stress are considered the key causes of morbidity and mortality among those in blast lung injury. It has been reported dimethylarginine dimethylaminohydrolase 1 (DDAH1) plays important roles in regulating vascular endothelial injury repair and angiogenesis, but its role in explosion-induced injury remains to be explained. Read More

Ear Hear 2022 Jul-Aug 01;43(4):1114-1124. Epub 2022 Jun 13.

Research Department, VA Healthcare San Diego, La Jolla, CA.

Objective: Tinnitus has been the No. 1 disability at the Veteran Administration for the last 15 years, yet its interaction with hearing loss secondary to etiologies such as age, noise trauma, and traumatic brain injuries remains poorly characterized. Our objective was to analyze hearing loss and tinnitus, including audiogram data, of the Million Veteran Program within the context of military exposures in an aging population. Read More

Leg Med (Tokyo) 2022 May 18;58:102090. Epub 2022 May 18.

Department of Forensic Medicine, Sechenov Moscow State Medical University, Moscow, Russia. Electronic address:

Background: Explosion fatalities are the severest type of violent crimes. These involve the use of explosive devices in terrorist like activities in confined spaces in civilian or military settings, with mass number of people present all around. A stark dearth of literature for the forensic interpretation of such catastrophes is astonishing. Read More

Prehosp Disaster Med 2022 May 23:1-10. Epub 2022 May 23.

School of Medicine and Health Sciences, George Washington University, Washington, DC USA.

Introduction: Blast polytrauma is among the most serious mechanisms of injury confronted by medical providers. There are currently no specific studies or guidelines that define risk factors for mortality in the context of pediatric blast injuries or describe pediatric blast injury profiles.

Objective: The objectives of this study were to evaluate risk factors for pediatric mortality and to describe differences in injury profiles between explosions related to terrorism versus unrelated to terrorism within the pediatric population. Read More

J Hand Surg Eur Vol 2022 Jul 17;47(7):687-697. Epub 2022 May 17.

The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Upper limb injuries are common in conflict zones. The functions of the upper limb are impossible to replicate with prosthetic replacement and wherever possible attempts should be made to preserve the limb with further secondary reconstruction aimed at restoration of function. Casualty assessment, haemorrhage control and resuscitation are simultaneously undertaken at the receiving medical facility. Read More

Front Neurosci 2022 29;16:853616. Epub 2022 Apr 29.

Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, United States.

Blast exposures that occur during training are common in military personnel; however, the biomarkers that relate to these subtle injuries is not well understood. Therefore, the purpose of this study is to identify the acute biomarkers related to blast injury in a cohort of military personnel exposure to blast-related training. Thirty-four military personnel who participated in the training program were included in this study. Read More

J Inflamm (Lond) 2022 May 12;19(1). Epub 2022 May 12.

Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.

Background: Assessment of immune status in critically ill patients is often based on serial tracking of systemic cytokine levels and clinical laboratory values. Exosomes are extracellular vesicles that can be secreted and internalized by cells to transport important cellular cargo in the regulation of numerous physiological and pathological processes. Here, we characterize the early compartmentalization profile of key proinflammatory mediators in serum exosomes in the steady state and following trauma. Read More

Headache 2022 Jun 11;62(6):700-717. Epub 2022 May 11.

Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.

Objective: This study deals with headache in relation to other major sequelae of traumatic brain injury (TBI) in veterans of Iraq and Afghanistan wars over 8 years after experiencing a deployment-related TBI (DTBI).

Background: TBI occurred in 14%-23% of veterans deployed to the Iraq or Afghanistan campaigns. This study evaluates sequelae of TBI (STBI) over 1-8 years after a DTBI. Read More

Mil Med 2022 May 11. Epub 2022 May 11.

Joint Trauma System, Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA.

Background: Military operations provide a unified action and strategic approach to achieve national goals and objectives. Mortality reviews from military operations can guide injury prevention and casualty care efforts.

Methods: A retrospective study was conducted on all U. Read More

Turk J Emerg Med 2022 Apr-Jun;22(2):96-103. Epub 2022 Apr 11.

Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Objectives: Disasters and mass casualty incidents (MCIs) that cause substantial mortality and morbidity have been increasing worldwide. The emergency department (ED) services manage MCIs by optimizing triage and providing health care with required resources. The present study attempted to describe the epidemiological characteristics and outcomes of MCIs presenting to the ED. Read More

Nepal J Epidemiol 2022 Mar 31;12(1):1156-1162. Epub 2022 Mar 31.

Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Gorakhpur, India.

A 49-year-old man sustained an accidental injury when he was changing and inflating the tyre of a truck, and there was a sudden explosion of the truck tyre at the service station, which was by the roadside of the highway. With the pressure of air generated due to the exploding tyre, the victim was blown to around 6 feet away. He was declared dead on admission. Read More

Stapp Car Crash J 2021 11;65:189-216

U.S. Army DEVCOM DAC, Aberdeen Proving Ground, MD, USA.

Fracture to the lumbo-pelvis region is prevalent in warfighters seated in military vehicles exposed to under-body blast (UBB). Previous high-rate vertical loading experimentation using whole body post-mortem human surrogates (PMHS) indicated that pelvis fracture tends to occur earlier in events and under higher magnitude seat input conditions compared to lumbar spine fracture. The current study hypothesizes that fracture of the pelvis under high-rate vertical loading reduces load transfer to the lumbar spine, thus reducing the potential for spine fracture. Read More

Mil Med 2022 05;187(Suppl 2):34-41

Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.

Introduction: During Operation Enduring Freedom in Afghanistan, an outbreak of combat-related invasive fungal wound infections (IFIs) emerged among casualties with dismounted blast trauma and became a priority issue for the Military Health System.

Methods: In 2011, the Trauma Infectious Disease Outcomes Study (TIDOS) team led the Department of Defense IFI outbreak investigation to describe characteristics of IFIs among combat casualties and provide recommendations related to management of the disease. To support the outbreak investigation, existing IFI definitions and classifications utilized for immunocompromised patients were modified for use in epidemiologic research in a trauma population. Read More

Mil Med 2022 05;187(Suppl 2):25-33

Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.

Introduction: Extremity trauma is the most common battlefield injury, resulting in a high frequency of combat-related extremity wound infections (CEWIs). As these infections are associated with substantial morbidity and may impact wounded warriors long after initial hospitalization, CEWIs have been a focus of the Infectious Disease Clinical Research Program (IDCRP). Herein, we review findings of CEWI research conducted through the IDCRP and discuss future and ongoing analyses. Read More

Surg Neurol Int 2022 15;13:151. Epub 2022 Apr 15.

Department of Neurosurgery, University of Foggia, Foggia, Puglia, Italy.

Background: Traumatic brain injury (TBI) is a well-known brain dysfunction commonly encountered in activities such as military combat or collision sports. The etiopathology can vary depending on the context and bomb explosions are becoming increasingly common in war zones, urban terrorist attacks, and civilian criminal feuds. Blast-related TBI may cause the full severity range of neurotrauma, from a mild concussion to severe, penetrating injury. Read More

Brain Inj 2022 Apr 4;36(5):607-619. Epub 2022 May 4.

Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

Primary Objectives: Determine if an abnormal preliminary neuroendocrine disorder (NED) blood test screen is associated with mild TBI (mTBI) history or post-concussiveclinical features.

Research Design: Observational.

Methods: Among 1,520 participants with military combatexposure, we measured randomly timed serum levels of insulin-likegrowth factor-1, thyroid stimulating hormone (TSH), and total testosterone as a preliminary NED screen. Read More

Neurology 2022 Apr 25. Epub 2022 Apr 25.

Department of Neurology, Columbia VA Healthcare System, Columbia, SC, USA

Objective: To examine the association between deployment-related Traumatic Brain Injury (TBI) severity, frequency, and other injury characteristics on headache outcomes in veterans evaluated at a Veterans Administration (VA) polytrauma support clinic.

Methods: We conducted a retrospective chart review of 594 comprehensive TBI evaluations between 2011-2021. Diagnostic criteria were based upon the Department of Defense/VA Consensus-Based Classification of Closed TBI. Read More

Clin Radiol 2022 Jul 24;77(7):529-534. Epub 2022 Apr 24.

Centre for Blast Injury Studies, Imperial College London, London, UK; Centre for Defence Radiology, HMS Nelson, Portsmouth, Hampshire, UK.

Aim: To evaluate the efficacy of Focused Assessment with Sonography in Trauma (FAST) in a paediatric population with a substantial proportion of penetrating abdominal injuries.

Materials And Methods: FAST and computed tomography (CT) abdomen findings were compared for 98 children who presented to Camp Bastion during the war in Afghanistan in 2011. FAST performance was compared to the reference standard of free fluid detected on CT. Read More