US Department of Defense
Advancing Blast Injury Research to Protect and Heal Those Who Serve

A Systematic Review of Traumatic Brain Injury Outcomes

Traumatic brain injury (TBI) is not only a civilian health concern, but it is often referred to as the "signature wound" of the ongoing conflicts in Iraq and Afghanistan. Since 2000, over 360,000 Service Members received a diagnosis of TBI and it is estimated that approximately half of these TBIs resulted from exposure to a blast. The precise physiological mechanisms of blast-related TBI as well as its comparisons to nonblast TBI that is often noted in civilian settings remain areas of great debate within the field.

The primary goal of a literature review recently published in the Journal of Head Trauma Rehabilitation was to determine whether US Service Members and Veterans who experienced blast-related TBI have a unique set of healthcare problems compared to those who experienced a nonblast TBI. Researchers from the Minneapolis VA Evidence-based Synthesis Program reviewed publications from January 2001 through June 2016, identifying 33 publications to include in their analysis. The work was intended to identify future research areas and improve care for Veterans with blast injuries and/or TBIs. Stakeholders included representatives from the Veterans Health Administration (VHA) TBI Advisory Committee; the VHA Rehabilitation Research and Development Service; and the Combat Casualty Care Research Program, US Army Medical Research and Materiel Command. Although there was notable variability across the selected studies with regard to sample size, injury characteristics, reported outcomes, and methods of assessment, researchers reported that Service Members and Veterans with blast-related and nonblast TBI experienced similar rates of depression, sleep disorders, alcohol misuse, vision loss, vestibular dysfunction, and functional status. On the other hand, the findings with regard to posttraumatic stress disorder (PTSD) diagnosis or symptoms, headache, hearing loss, and neurocognitive function between the blast-related and nonblast TBI groups were inconsistent across studies.

Researchers concluded that overall most clinical and functional outcomes are comparable in military Service Members and Veterans with TBI, regardless of how they sustained their TBI. However, blast-related TBI represents a heterogeneous injury due to great variability in the unique characteristics of the blast that individuals are exposed to. Unfortunately, due to limited information, researchers were unable to characterize outcomes among those who had experienced blast-related TBI based on specific blast characteristics which was the secondary goal of the review. Inconsistent findings, limited reported outcomes, and incomplete information regarding blast characteristics across published studies indicate that future research focusing on comprehensive and consistent documentation of blast characteristics and long-term injury outcomes is needed to fully characterize the differences in health outcomes caused by blast-related and nonblast TBI.

This work was funded by the Department of Veteran Affairs Evidence-Based Synthesis Program. The learn more about the project, read the complete evidence report.


Greer, N., Sayer, N., Koeller, E., Velasquez, T., Wilt, T. (2017). Outcomes Associated With Blast Versus Nonblast-Related Traumatic Brain Injury in US Military Service Members and Veterans: A Systematic Review. J Head Trauma Rehabil. doi: 10.1097/HTR.0000000000000304. [Epub ahead of print]

Last modified: 03-Apr-2023