Fatal head and neck injuries in military underbody blast casualties
File(s)
Author(s)
Stewart, Sarah K
Pearce, AP
Clasper, Jon C
Type
Journal Article
Abstract
INTRODUCTION: Death as a consequence of underbody blast (UBB) can most commonly be attributed to central nervous system injury. UBB may be considered a form of tertiary blast injury but is at a higher rate and somewhat more predictable than injury caused by more classical forms of tertiary injury. Recent studies have focused on the transmission of axial load through the cervical spine with clinically relevant injury caused by resultant compression and flexion. This paper seeks to clarify the pattern of head and neck injuries in fatal UBB incidents using a pragmatic anatomical classification. METHODS: This retrospective study investigated fatal UBB incidents in UK triservice members during recent operations in Afghanistan and Iraq. Head and neck injuries were classified by anatomical site into: skull vault fractures, parenchymal brain injuries, base of skull fractures, brain stem injuries and cervical spine fractures. Incidence of all injuries and of each injury type in isolation was compared. RESULTS: 129 fatalities as a consequence of UBB were identified of whom 94 sustained head or neck injuries. 87 casualties had injuries amenable to analysis. Parenchymal brain injuries (75%) occurred most commonly followed by skull vault (55%) and base of skull fractures (32%). Cervical spine fractures occurred in only 18% of casualties. 62% of casualties had multiple sites of injury with only one casualty sustaining an isolated cervical spine fracture. CONCLUSION: Improvement of UBB survivability requires the understanding of fatal injury mechanisms. Although previous biomechanical studies have concentrated on the effect of axial load transmission and resultant injury to the cervical spine, our work demonstrates that cervical spine injuries are of limited clinical relevance for UBB survivability and that research should focus on severe brain injury secondary to direct head impact.
Date Issued
2019-01-24
Date Acceptance
2018-03-19
Citation
Journal of the Royal Army Medical Corps, 2019, 165 (1), pp.18-21
ISSN
2052-0468
Publisher
BMJ Publishing Group
Start Page
18
End Page
21
Journal / Book Title
Journal of the Royal Army Medical Corps
Volume
165
Issue
1
Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29680818
PII: jramc-2018-000942
Subjects
blast
brain injury
survivability
underbody blast
Adult
Afghan Campaign 2001-
Afghanistan
Blast Injuries
Craniocerebral Trauma
Female
Humans
Iraq
Iraq War, 2003-2011
Male
Military Personnel
Neck Injuries
Retrospective Studies
United Kingdom
Young Adult
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2018-04-21