closed question and that longer-term followup, especially in large registry-based studies, is warranted to determine whether there is a measurable increase in risk and, if so, when it is most likely to be observed. For now, the committee concludes that the inconsistent results among the studies are most supportive of a classification of inadequate and insufficient evidence to determine whether an association exists.

RECOMMENDATIONS

Scoring of Severity of Blast-Induced Neurotrauma

Blast-induced neurotrauma (BINT) is a complex type of TBI that features closed (blunt) head injury that may be accompanied by a penetrating brain injury. The pathobiology of BINT parallels that of TBI. Because moderate, moderate to severe, and severe BINT is often part of complex polytrauma, proper diagnosis of BINT should include both classification of blast injuries and scoring of the severity of head injury. The most recent version of the AIS incorporates blast injuries and is regularly used by the US Army; it can be used for global scoring of all injuries. In hospitals, the modified Pathology Scoring System can yield additional information that might be valuable in designing treatment strategies and predicting outcomes. A combination of the head AIS, as an anatomic measure, and the GCS, as a physiologic measure of brain-injury severity, is useful in initial estimation of brain damage. Nevertheless, use of additional TBI scoring systems is recommended, especially in the case of mild TBI or suspected concussion or when medical records provide less detailed information about the injury and its circumstances. In the military environment, use of the Brief Traumatic Brain Injury Screen and the Military Acute Concussion Evaluation is recommended for every soldier who has a history of blast exposure (even low-intensity blast exposure).

The committee recommends that the Department of Defense use the Brief Traumatic Brain Injury Screen and the Military Acute Concussion Evaluation for every soldier who has a history of blast exposure (even of low-intensity blast exposure).

Experimental and Clinical Studies of Blast-Induced Neurotrauma

Blast injury, especially BINT, is a continuing threat to our troops. In both civilian and military environments, exposure to a blast might cause instant death, injuries with immediate manifestation of symptoms, or injuries with delayed manifestation. There is a paucity of information in the scientific literature regarding the sequelae of blast injury, and there is a need for prospective, longitudinal studies to confirm reports of long-term effects of exposure to blasts. Because of lack of information, adverse neurologic and behavioral changes in blast victims might be underestimated, and valuable time for preventive therapy or timely rehabilitation might be lost.

The committee recommends that the Department of Defense and the Department of Veterans Affairs support prospective, longitudinal studies to confirm reports of long-term or latent effects of exposure to blasts. Those studies should examine the consequences of blast-induced neurotrauma, recovery timeline, and any factors that improve or worsen outcomes.



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