Blast traumatic brain injury: the history, pathology and mechanisms of injury
File(s)
Author(s)
Ashworth, Emily
Type
Thesis
Abstract
Blast brain injury is known to have a high morbidity and mortality rate in the Iraq and Afghanistan commitments, equating to around 19% of all injuries and was prevalent in historic conflicts such as World War 2 (WW2).
The documentation and imaging from the St Hugh’s College in Oxford archives gives an insight into the type of injuries suffered in WW2 pioneering treatments offered in contrast to the commitments of 2003-2012.
In addition to the WW2 archives, patients were identified from the Iraq and Afghanistan commitments between 2003-2012. These patients were collated from the Joint Trauma and Theatre Registry (JTTR) and the associated imaging identified, including computerised tomography post-mortems (CTPM), computerised tomography (CT) scans, magnetic resonance imaging and radiological reports.
In order to classify the CT scans, a CT-based scoring system was constructed and validated on a civilian cohort using inter-rater reliability and then used in the military cohort.
Chi’s squared and Fisher’s exact were used to identify constellations or mechanisms of injury. Distinct mechanisms of both mounted and dismounted blast were identified from Iraq and Afghanistan. In the mounted cohort, there were 3 distinct patterns of injury; an eggshell pattern of fractures, 3 or 4 point spinal fractures and perimesencephalic blood. In the dismounted cohort perimesencephalic blood was again visualised in conjunction with thoracic injury and there was a higher incidence of penetrating injury in comparison to the mounted cohort.
Brain injury pathology varied greatly between WW2 and the Iraq/Afghanistan campaigns, largely due to the development of improvised explosive devices. Although the imaging from WW2 was crude with only plain film x-rays, it demonstrates that penetrating injury was prevalent in both conflicts.
Many of the injuries identified are not amenable to clinical treatment and therefore efforts should be made to identify mitigation strategies from the hypothesised injury mechanisms.
The documentation and imaging from the St Hugh’s College in Oxford archives gives an insight into the type of injuries suffered in WW2 pioneering treatments offered in contrast to the commitments of 2003-2012.
In addition to the WW2 archives, patients were identified from the Iraq and Afghanistan commitments between 2003-2012. These patients were collated from the Joint Trauma and Theatre Registry (JTTR) and the associated imaging identified, including computerised tomography post-mortems (CTPM), computerised tomography (CT) scans, magnetic resonance imaging and radiological reports.
In order to classify the CT scans, a CT-based scoring system was constructed and validated on a civilian cohort using inter-rater reliability and then used in the military cohort.
Chi’s squared and Fisher’s exact were used to identify constellations or mechanisms of injury. Distinct mechanisms of both mounted and dismounted blast were identified from Iraq and Afghanistan. In the mounted cohort, there were 3 distinct patterns of injury; an eggshell pattern of fractures, 3 or 4 point spinal fractures and perimesencephalic blood. In the dismounted cohort perimesencephalic blood was again visualised in conjunction with thoracic injury and there was a higher incidence of penetrating injury in comparison to the mounted cohort.
Brain injury pathology varied greatly between WW2 and the Iraq/Afghanistan campaigns, largely due to the development of improvised explosive devices. Although the imaging from WW2 was crude with only plain film x-rays, it demonstrates that penetrating injury was prevalent in both conflicts.
Many of the injuries identified are not amenable to clinical treatment and therefore efforts should be made to identify mitigation strategies from the hypothesised injury mechanisms.
Version
Open Access
Date Issued
2024-01-03
Date Awarded
01/12/2024
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Bull, Anthony
Wilson, Mark
Sponsor
Royal British Legion
Publisher Department
Bioengineering
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)