Blast Injury from Explosive Munitions

Military Medical Academy, Belgrade, Yugoslavia.
The Journal of trauma (Impact Factor: 2.96). 08/1999; 47(1):96-103; discussion 103-4. DOI: 10.1097/00005373-199907000-00021
Source: PubMed


To evaluate the effect of blast in common war injuries.
One thousand three hundred and three patients injured by explosive munitions and demonstrating extremity wounds without other penetrating injuries were admitted to the Military Medical Academy in Belgrade between 1991 and 1994. Of these, 665 patients (51%) had symptoms and physical signs that were compatible with the clinical diagnosis of primary blast injury, whereas the remaining 658 patients did not.
Random sampling of 65 patients in the blast group during the early posttraumatic period showed statistically significant elevations in blood thromboxane A2 (TxA2), prostacyclin (PGI2), and sulfidopeptide leukotrienes compared with the random sample of 62 patients in the nonblast group. This difference could not be accounted for by differing injury severity between the groups, because the severity of wounds as measured by both the Injury Severity Score and the Red Cross Wound Classification was similar in both groups. Amongst blast patients, 200 patients (30%) had long-term (1 year) symptoms and signs reflecting central nervous system disorders. These symptoms and signs were only sporadically found in 4% of the nonblast patients. These findings indicate that primary blast injury is more common in war injuries than previously thought and that of those affected by blast, a surprisingly high proportion retain long-term neurologic disability. The elevation in eicosanoids could be used to confirm and monitor blast injury.
In relation to the immediate management of patients injured by explosive weapons, it follows that particular attention should be paid to the presence and/or development of blast injury. Our findings indicate that blast is more common in war injuries than previously thought. Eicosanoid changes after blast injury suggest that blast injury causes a major physiologic stress. A variety of effects on the central nervous system suggest that blast injury could be responsible for some aspects of what is now considered to be the posttraumatic stress disorder.

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    • "Regardless of the specific outcome, there is growing evidence that noise exposure, either from blast wave or continuous high intensity noise, can have an effect on hippocampal neurogenesis. Previous studies have demonstrated that blast exposure has a significant impact on memory in rodents (Cernak et al., 2001; Ahlers et al., 2012) and cognitive functioning in humans (Cernak et al., 1999; Martin et al., 2008; Cernak, 2010). Our result of a long-term reduction in neurogenesis in the hippocampus following blast exposure may underlie these findings given the implicated involvement of hippocampal neurogenesis in memory and cognitive functioning (Deng et al., 2010). "
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    • "Another hypothesized primary mechanism is that shock waves impact the torso and are then transmitted to the brain causing TBI (27–31). In particular, it has been proposed that, indirect transmission of kinetic energy from the blast shock wave traveling through the large vessels of the body plays a key role in causing TBI. "
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    • "Civilian and military personnel exposure to violent explosions , often from improvised explosive devices (IEDs), has burgeoned with recent world events (Aschkenasy- Steuer et al. 2005; Cernak et al. 1999; DuBose et al. 2011). In military populations, a RAND report (Tanielian and Jaycox 2008) estimated that as many as 20% (320,000) of military personnel experienced some form of traumatic brain injury (TBI). "
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