Blast Injury Patterns Among Israel Defense Forces Fatalities

Josef Daniel Shakargy; Sami Gendler; Tomer Talmy; Guy Shushan; Irina Radomislensky; Avishai M Tsur; Ofer Almog; Guy Avital; Avi Benov; Shaul Gelikas

doi:10.1093/milmed/usac280

Blast Injury Patterns Among Israel Defense Forces Fatalities

Mil Med. 2022 Oct 7:usac280. doi: 10.1093/milmed/usac280. Online ahead of print.

Authors

Josef Daniel Shakargy¹, Sami Gendler¹, Tomer Talmy^{1

2}, Guy Shushan^{1

3}, Irina Radomislensky⁴, Avishai M Tsur^{1

5}, Ofer Almog^{1

2}, Guy Avital^{1

6}, Avi Benov^{1

7}, Shaul Gelikas^{1

5}

Affiliations

¹ The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan 02149, Israel.
² Department of Military Medicine, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 91120, Israel.
³ Ground forces Technology Unit, Tel-Hashomer, Israel Defense Forces, Ramat Gan 02149, Israel.
⁴ The Israel National Center for Trauma & Emergency Medicine Research, Gertner Institute of Epidemiology and Health Policy Research, Tel Aviv 5262000, Israel.
⁵ Sheba Medical Center Hospital-Tel-Hashomer, Ramat Gan 5262000, Israel.
⁶ Division of Anesthesia, Intensive Care & Pain Management, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel.
⁷ The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel.

PMID: 36205252
DOI: 10.1093/milmed/usac280

Abstract

Introduction: The incidence of blast injuries on the battlefield has risen over the last several decades. In order to improve prevention and treatment, it is essential to understand the severity and bodily distribution of these injuries. This study aims to characterize blast injury patterns among IDF fatalities.

Materials and methods: This is a descriptive, retrospective study on postmortem reports of military-blast fatalities between the years 1982 and 2021. Body regions injured according to the Abbreviated Injury Scale (AIS) were described. The frequency of body region injury combinations was mapped, and the correlation between injured body regions was calculated using Pearson's coefficient. Analysis of a subgroup with a postmortem computed tomography (CT-PM) or autopsy was performed, describing severe (AIS ≥ 3) injury patterns.

Results: Overall, 222 fatalities suffered from blast injury, with most injuries affecting the upper and lower extremities (63.7% and 66.5%, respectively), followed by the head (57.1%) and the thorax (56.6%). The median number of injured body regions was 4 (interquartile range, 2-5). The most frequent injury combinations were the upper and lower extremities (51%), the upper extremities and the thorax (45%), and the lower extremities and the thorax (41%). In all, 47/222 (21.2%) fatalities had a documented autopsy or CT-PM report. Among the fatalities with CT-PM or autopsy, the head (63.8%) and the thorax (57.4%) were most frequently severely injured (AIS ≥ 3).

Conclusions: Among blast fatalities in the military setting, the extremities were most commonly injured. However, data suggest that the head and thorax are more likely to sustain severe blast injuries resulting in mortality. Blast injuries in this cohort were characterized by concomitant involvement of several regions. Development of protective gear to minimize the multisystem injuries inflicted by blast injuries is warranted and should be focused on distinct types and anatomical distribution of severe blast injuries as reported in this study.

Level of evidence: Level III, Retrospective analysis.