US Department of Defense
BLAST INJURY RESEARCH
COORDINATING OFFICE
Advancing Blast Injury Research to Protect and Heal Those Who Serve
To understand the impacts on human health, research on blast exposure is often conducted by collaborative research teams representing many disciplinary backgrounds, including medicine, engineering, and physics. A common language to describe essential concepts such as high-level blast (HLB), low-level blast (LLB), acute and chronic exposures, or acute and chronic outcomes, is distinctly missing, often due to discipline-specific uses of these terms. Standardized terminology is needed to enhance the ability of multi-disciplinary researchers to interpret study methods and findings, integrate findings across studies to reach consensus, and decrease the likelihood of redundant efforts, thus bringing a common dialogue to the field. Consistent terminology can facilitate important discoveries in preventing, screening, and treating injuries sustained during blast events.
A research team1 at the Naval Health Research Center conducted a scoping review2 of peer-reviewed papers focused on the health-related impacts of blast overpressure during the past 20 years. To account for inconsistency in terminology usage, they used a variety of search terms and phrases, resulting in 5,600 articles for potential inclusion before narrowing the total to 3,215 by using the title and abstract of each to determine relevancy to HLB and/or LLB. Ultimately, they found hundreds of terms used to describe HLB and LLB, with shockingly few (seven percent and four percent respectively) meeting their threshold of "commonly used" terms; some were used to describe both types of blast within the same article, leaving the distinction between the two unclear although each may impact health outcomes differently. To address this issue, they have created a list of terminology with definitions, clarifying key terms used to describe blast exposure, the distinction between HLB and LLB, and proper use of the terms "acute", "chronic", "exposures", and "outcomes" when referring to blast exposure and its health-related challenges, hoping to influence future research by achieving consensus on relevant terminology.
Researchers offer definitions of HLB and LLB that rely on the source of the blast as the distinguishing factor, rather than the peak overpressure threshold. HLB is the result of incoming munitions and typically occurs in operational settings, is higher in experienced overpressure, is not predictable, and is associated with primary through quinary blast injuries; in contrast, LLB is the result of outgoing munitions and typically occurs during both training and operational environments, is lower in experienced overpressure, can presumably be predicted if one knows the unit's operational tempo and training schedule, and may be associated with only primary blast injury. The researchers also suggest that injury be considered along a continuum of non-injured to severely-injured. The analysis of another set of terms: "acute", "chronic", "exposures", and "outcomes", resulted in similar ambiguity, with inconsistent distinctions between the concepts of "acute" and "chronic" exposures, and "acute" and "chronic" outcomes, blurring the important temporal aspects of these phrases and the subsequent health-related consequences.
Ensuring that everyone is speaking the same language is an important step in moving advances in research from bench to bedside. It is of note that the DOD Blast Injury Research Coordinating Office (BIRCO) chaired a NATO working group on standardizing blast injury terminology and research methodology. In addition to a series of published articles, the working group created a dictionary of blast injury terms. The dictionary, along with their final report, can be found here.
1 Belding JN, Egnoto M, Englert RM, Fitzmaurice S and Thomsen CJ (2021). Getting on the Same Page: Consolidating Terminology to Facilitate Cross-Disciplinary Health-Related Blast Research. Front. Neurol. 12:695496. doi: 10.3389/fneur.2021.695496.
2 Belding JN, Englert RM, Fitzmaurice S, Jackson JR, Koenig HG, Hunter MA, Thomsen CJ and UO da Silva (2021) Potential Health and Performance Effects of High-Level and Low-Level Blast: A Scoping Review of Two Decades of Research. Front. Neurol. 12:274. doi: 10.3389/fneur.2021.628782.
This work was funded by the U.S. Army Medical Research and Development Command, under work unit no. N1629.
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