Injury scoring systems for blast injuries: a narrative review

Abstract

Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blastspecific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.

Esophageal pressure monitoring and its clinical significance in severe blast lung injury

“…Efforts are ongoing to identify early detection techniques and strategies for maintaining respiratory function post-injury. Unlike traditional acute lung injury models developed through methods such as intravenous injection of endotoxin, intratracheal instillation of oleic acid, exposure to high oxygen levels, or ventilator-induced injury ( Champion et al, 2009 ; Matute-Bello et al, 2011 ; Hazell et al, 2022 ; Rozenfeld et al, 2022 ), blast injury replicates acute blunt traumatic lung injury caused by external forces impacting the lungs. This mode of injury differs significantly in its mechanism and impact from previous models, which failed to accurately replicate the nuances of acute traumatic blunt lung injuries, particularly lung contusions.…”

“…Currently, both nationally and internationally, there is a paucity of research on the changes in respiratory mechanics following severe BLI. Most animal-based studies have focused on the mechanisms of injury, post-injury pathophysiological alterations, and their underlying molecular mechanisms ( Scott et al, 2017 ; Nguyen et al, 2019 ; Smith and Garner, 2019 ; Hazell et al, 2022 ; Shakargy et al, 2022 ; Al-Hajj et al, 2023 ). There has been insufficient exploration into the maintenance programs for post-injury respiratory function, especially those concerning variations in respiratory mechanics parameters monitored by Pes in animals afflicted with severe BLI; such studies are notably absent in the existing literature.…”