Recognizing, scoring, and predicting blast injuries

The aim of this study was to find relevant signs and readily available para meters for the recognition of blast injuries and estimation of their severi ty. The injury severity, estimated by the Injury Severity Score (ISS), Red Cross Wound Classification (RCWC), and experimentally defined Pathology Sco ring System for Blast Injuries (PSS/IS) according to Yelverton and modified for use in humans, was compared with a great number of subjective sensatio ns, clinical signs, parameters of hemodynamic, metabolic, neuroendocrine an d immune conditions. On the basis of these data, the confidence of the abov e-mentioned methods was analyzed in the evaluation of blast injuries. This study included 1303 casualties, wounded by explosive devices and with suspe cted blast injuries, treated at the Military Medical Academy in Belgrade (M MA) from 1991 to 1994. The patients were examined on admission at the MMA ( <18 hours) and during hospitalization (1, 2, 5, and 7 days after wounding). The casualties with confirmed blast injury (n = 665, 51%) had an ISS rangi ng from 0 to 34 (mean 13) had wounds ranging from CIST (soft tissue wounds caused by low energy transfer) to G3VF (massive wounds with fractures and i njury of vital structures) according to the RCWC, with PSS/IS scores from 2 to 105 (mean 60). Statistically significant correlation was found between ISS and PSS/IS as well as RCWC and PSS/IS. Cytokines (IL-1, TNFalpha) and a mino acids responded to a blast injury in similar manner as to gunshot woun ds with a greater ISS or more severe RCWC injury type. The subjective sensa tions in blasted patients (deafness, thoracic pain, vertigo) and mediators, confirmed in previous experimental investigations as important factors in the pathogenesis of blast injuries (TxA(2), sulfidopeptide leukotrienes) we re relationed only to the PSS/IS.