Abstract
Although blast exposure has been recognized as a significant source of morbidity and mortality in military populations, our understanding of the effects of blast exposure, particularly low-level blast (LLB) exposure, on health outcomes remains limited. This scoping review provides a comprehensive, accessible review of the peer-reviewed literature that has been published on blast exposure over the past two decades, with specific emphasis on LLB. We conducted a comprehensive scoping review of the scientific literature published between January 2000 and 2019 pertaining to the effects of blast injury and/or exposure on human and animal health. A three-level review process with specific inclusion and exclusion criteria was used. A full-text review of all articles pertaining to LLB exposure was conducted and relevant study characteristics were extracted. The research team identified 3,215 blast-relevant articles, approximately half of which (55.4%) studied live humans, 16% studied animals, and the remainder were non-subjects research (e.g., literature reviews). Nearly all (99.49%) of the included studies were conducted by experts in medicine or epidemiology; approximately half of these articles were categorized into more than one medical specialty. Among the 51 articles identified as pertaining to LLB specifically, 45.1% were conducted on animals and 39.2% focused on human subjects. Animal studies of LLB predominately used shock tubes to induce various blast exposures in rats, assessed a variety of outcomes, and clearly demonstrated that LLB exposure is associated with brain injury. In contrast, the majority of LLB studies on humans were conducted among military and law enforcement personnel in training environments and had remarkable variability in the exposures and outcomes assessed. While findings suggest that there is the potential for LLB to harm human populations, findings are mixed and more research is needed. Although it is clear that more research is needed on this rapidly growing topic, this review highlights the detrimental effects of LLB on the health of both animals and humans. Future research would benefit from multidisciplinary collaboration, larger sample sizes, and standardization of terminology, exposures, and outcomes.
Highlights
Modern explosives have grown increasingly destructive over time and have been identified as the leading cause of injuries in recent conflicts such as Operation Enduring Freedom and Operation Iraqi Freedom [1]
There was only a single study directly examining adverse outcomes in the visual system, this study suggested that LLB can result in acute injury to the eye [29], which has the potential to affect warfighter performance, for special forces operators [72]
This highlights the complexity of blast effects on human tissues and underscores the importance of interdisciplinary approaches to blast injury research
Summary
Modern explosives have grown increasingly destructive over time and have been identified as the leading cause of injuries in recent conflicts such as Operation Enduring Freedom and Operation Iraqi Freedom [1]. When most people think of explosive blasts, the image that comes to mind is a high-level blast (HLB), such as the detonation of an improvised explosive device in combat or a terrorist attack such as the Boston Marathon Bombing in 2013. In such cases, explosives emit a blast wave which causes a transient increase in overpressure, followed by a negative pressure phase, before returning to ambient pressure. Those that are nearby can be subject to injury through five mechanisms: the overpressure wave (i.e., primary blast injury), debris (i.e., secondary blast injury), physical displacement of one’s body (i.e., tertiary blast injury), heat and toxins (i.e., quaternary blast injury), and environmental contaminants (i.e., quinary blast injury) [7,8,9]
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