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.

Additionally, animal models provide the framework for predicting outcomes and developing optimal therapeutics for BINT; however, after reviewing the literature, the committee came to the conclusion that there is a need for more refined animal models of BINT. They should be aligned with emerging data on the human response to BINT. The accessibility to acute clinical data on human BINT from DoD and VA is essential for refining the animal models.

The committee recommends that the Department of Defense and the Department of Veterans Affairs support research on animal models of blast-induced neurotrauma. Consideration should be given to developing models that would be relevant to human traumatic brain injury that encompass a more comprehensive experimental design. That could include studies that measure both behavior and pathology that might differ by traumatic brain injury severity. It would be



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