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

Epidemiology of Blast Neurotrauma: A Meta-Analysis of Blast Injury Patterns in the Military and Civilian Populations

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Of the nearly 200,000 unique events related to terrorism occurring worldwide since 1970, bombings are the most common event that affect both military and civilian populations. This is of particular importance for medical providers, especially those in highly-targeted areas such as the Middle East and Western Asia, as they need to be prepared to receive and treat patients with blast-related injuries. However, there has been little investigation to summarize key details of blast injury profiles in global terrorist bombings, or to analyze differences in blast injury profiles between military and civilian populations. To address this knowledge gap, researchers from the George Washington University School of Medicine and Health Sciences, Walter Reed National Military Medical Center, and Uniformed Services University of Health Sciences conducted a meta-analysis to determine the differences between blast injury profiles reported for casualties from these two populations.1

A systematic literature review and statistical analysis of a total of 33,387 unique injuries (n = 18,711 military, n = 14,676 civilian) found several differences in the blast injury profiles between military and civilian personnel. Most notable was the significant difference between injuries reported in the head and neck regions, with 29.4 percent of all reported injuries in the military population occurring in these regions as compared to only 12.7 percent reported in the civilian population. Despite this, the prevalence of head and neck injury as a cause-of-death was not significantly different between populations. Conversely, civilian populations reported a marginally higher rate of chest and abdominal injuries and a greater prevalence of penetrating injury in these regions as a cause-of-death.

Given that military personnel typically wear protective body armor and ballistic helmets, it was somewhat unexpected that this population had an increased rate of head and neck injuries; however, this may be due to the improper use of ballistic helmets, which contradictorily would increase blast exposure. Also, despite the increased rate of head and neck injury, blast injury did not significantly increase the rate of head trauma as a cause-of-death in military populations, suggesting that the use of protective gear is still effective in reducing the lethality of blast injury. Furthermore, the use of body armor by military, but not civilian, personnel may also explain the higher rate of chest and abdominal injuries and greater lethality of these injuries in civilian populations, as body armor provides protection against blast injuries in these body regions. Together, these findings suggest that medical facilities may observe differences in the type and severity of blast-related injuries depending on the populations they receive (military versus civilian), and emphasize the importance of specialized medical services at these facilities to mount a sufficient response to mass casualty scenarios related to terrorism bombings.


1 Tovar MA, Bell RS, Neal CJ, Epidemiology of Blast Neurotrauma: A Meta Analysis of Blast Injury Patterns in the Military and Civilian Populations., World Neurosurgery (2020),doi:


This research did not receive any specific grant from funding agencies in the public,commercial, or not-for-profit sectors.

Last modified: 12-Jan-2021