The epidemiology of blast lung injury during recent military conflicts: a retrospective database review of cases presenting to deployed military hospitals, 2003–2009

Smith, Jessi L.

doi:10.1098/rstb.2010.0251

Cited by 80 publications

(48 citation statements)

References 10 publications

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“…While this is a very 'safe' definition of blast lung where it is essential to exclude all other possibilities, it will exclude blast lung injuries when it co-exists with other injury types, which is common with conventional munitions and terrorist bombs and hence may underestimate the occurrence of blast lung in current in military casualties. Perhaps the most recent assessment of the incidence is given by Smith et al [13], where the incidence was found to be approximately 11 per cent in casualties who also suffered other (particularly penetrating) injuries.…”

Section: Classification Of Blast Injuriesmentioning

confidence: 99%

Blast injury research models

Kirkman

Watts

Cooper

2011

Phil. Trans. R. Soc. B

106

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Blast injuries are an increasing problem in both military and civilian practice. Primary blast injury to the lungs (blast lung) is found in a clinically significant proportion of casualties from explosions even in an open environment, and in a high proportion of severely injured casualties following explosions in confined spaces. Blast casualties also commonly suffer secondary and tertiary blast injuries resulting in significant blood loss. The presence of hypoxaemia owing to blast lung complicates the process of fluid resuscitation. Consequently, prolonged hypotensive resuscitation was found to be incompatible with survival after combined blast lung and haemorrhage. This article describes studies addressing new forward resuscitation strategies involving a hybrid blood pressure profile (initially hypotensive followed later by normotensive resuscitation) and the use of supplemental oxygen to increase survival and reduce physiological deterioration during prolonged resuscitation. Surprisingly, hypertonic saline dextran was found to be inferior to normal saline after combined blast injury and haemorrhage. New strategies have therefore been developed to address the needs of blast-injured casualties and are likely to be particularly useful under circumstances of enforced delayed evacuation to surgical care.

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Section: Classification Of Blast Injuriesmentioning

confidence: 99%

Blast injury research models

Kirkman

Watts

Cooper

2011

Phil. Trans. R. Soc. B

106

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“…The lungs showed the most severe damage after the blast injury [1,27,28]. In the burn-blast combined injury group, the lungs were also severely damaged.…”

Section: Discussionmentioning

confidence: 93%

“…With the development of high-technology weaponry, the morbidity of combined injuries sustained in local wars and terrorist attacks has increased rapidly [1,2]. The detonation of an explosive generates shock wave and heat, causing burn-blast combined injury and aggravating the wound by the interaction of blast and burns [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Development of an Animal Model for Burn-Blast Combined Injury and Cardiopulmonary System Changes in the Early Shock Stage

Chai

et al. 2014

Indian J Surg

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The purposes of this study were to establish an animal model for burn-blast combined injury research and elaborate cardiopulmonary system changes in the early shock stage. In this study, royal demolition explosive or RDX (hexagon, ring trimethylene nitramine) was used as an explosive source, and the injury conditions of the canine test subjects at various distances to the explosion (30, 50, and 70 cm) were observed by gross anatomy and pathology to determine a larger animal model of moderate blast injury. The canines were then subjected to a 35 % total body surface area (TBSA) full-thickness flame injury using napalm, which completed the development of a burn-blast combined injury model. Based on this model, the hemodynamic changes and arterial blood gas analysis after the burnblast combined injury were measured to identify the cardiopulmonary system characteristics. In this research, RDX explosion and flame injury were used to develop a severe burn-blast injury animal model that was stable, close to reality, and easily controllable. The hemodynamic and arterial blood gas changes in the canine subjects after burn-blast injury changed distinctly from the burn and blast injuries. Blood pressure and cardiac output fluctuated, and the preload was significantly reduced, whereas the afterload significantly increased. Meanwhile, the oxygen saturation (SO 2 ) decreased markedly with carbon dioxide partial pressure (PCO 2 ), and lactic acid (Lac) rose, and oxygen partial pressure (PO 2 ) reduced. These changes suggested that immediate clinical treatment is important during burn-blast injury both to stabilize cardiac function and supply blood volume and to reduce the vascular permeability, thereby preventing acute pneumonedema or other complications.

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“…14 The default entry criterion for UK JTTR is a casualty who triggers trauma team activation in a deployed field hospital or Primary Casualty Receiving Facility afloat. The entry criteria were expanded in 2007 to include all trauma patients returned to Royal Centre for Defence Medicine for definitive treatment, irrespective of whether a trauma team response was mandated.…”

Section: Methodsmentioning

confidence: 99%

“…Anonymised data were supplied from the JTTR database, and according to institutional agreement ethical approval was not required. 14 Only patients with complete recordings of their physiological parameters on arrival at hospital were included in the study (SBP, HR, GCS, RR). Due to the nature of the JTTR and its inclusion criteria, patients in the study were assumed to be non-ambulant.…”

Section: Methodsmentioning

confidence: 99%

Major incident triage: Derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT)

Vassallo

Beavis

Smith

et al. 2017

Injury

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Major Incident triage: derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT). Background:Triage is a key principle in the effective management at a major incident. There are at least three different triage systems in use worldwide and previous attempts to validate them, have revealed limited sensitivity. Within a civilian adult population, there has been no work to develop an improved system. Methods:A retrospective database review of the UK Joint Theatre Trauma Registry was performed for all adult patients (>18 years) presenting to a deployed Military Treatment Facility between 2006-2013.Patients were defined as Priority One if they had received one or more life-saving interventions from a previously defined list.Using first recorded hospital physiological data (HR/RR/GCS), binary logistic regression models were used to derive optimum physiological ranges to predict need for life-saving intervention. This allowed for the derivation of the Modified Physiological Triage Tool -MPTT (GCS<14, HR>100, 1222). A comparison of the MPTT and existing triage tools was then performed using sensitivities and specificities with 95% confidence intervals. Differences in performance were assessed for statistical significance using a McNemar test with Bonferroni correction. Results:Of 6095 patients, 3654 (60.0%) had complete data and were included in the study, with 1738 (47.6%) identified as priority one. Existing triage tools had a maximum sensitivity of 50.9% (Modified Military Sieve) and specificity of 98.4% (Careflight). The MPTT (sensitivity 69.9%, 95% CI 0.677-0.720, specificity 65.3%, 95% CI 0.632-0.675) showed an absolute increase in sensitivity over existing tools ranging from 19.0% (Modified Military Sieve) to 45.1% (Triage Sieve). There was a statistically significant difference between the performance (p < 0.001) between the MPTT and the Modified Military Sieve. Discussion & Conclusion:The performance characteristics of the MPTT exceed existing major incident triage systems, whilst maintaining an appropriate rate of over-triage and minimising under-triage within the context of predicting the need for a life-saving intervention in a military setting. Further work is required to both prospectively validate this system and to identify its performance within a civilian environment, prior to recommending its use in the major incident setting. Keywords:Triage, Major incidents, life-saving intervention, physiological predictors

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The epidemiology of blast lung injury during recent military conflicts: a retrospective database review of cases presenting to deployed military hospitals, 2003–2009

Cited by 80 publications

References 10 publications

Blast injury research models

Blast injury research models

Development of an Animal Model for Burn-Blast Combined Injury and Cardiopulmonary System Changes in the Early Shock Stage

Major incident triage: Derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT)

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