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Polytrauma and Blast-Related Injuries

By: United States Department of Veterans Affairs

The scope of the PT/BRI QUERI includes the full range of health problems, health care system and psychosocial factors represented in this mission. However, PT/BRI QUERI focuses on filling gaps and implementing research to improve health outcomes for two high priority and prevalent blast-related injuries that occur in the context of other combat injuries: Traumatic Brain Injury (TBI) and traumatic amputation.

In this era of modern warfare, America’s Armed forces are sustaining new and complex injuries – the majority of which are blast-related. In combat, sources of blast injury include improvised explosive devices (IEDs), artillery, rocket and mortar shells, mines, booby traps, aerial bombs and rocket propelled grenades. By the end of March, 2007, 23,407 service members have sustained non-mortal injuries in the wars in Iraq and Afghanistan, nearly one half of whom did not return to duty within 72 hours, presumably because of the severity of their injuries. The severity and pattern of blast injuries depends on the explosive composition and amount of material involved, the surrounding environment, delivery method, distance between the victim and the blast, and the presence of intervening protective barriers or environmental hazards. Due to improvements in body armor and field trauma care, more individuals are surviving beyond the acute phase of these injuries. Consequently, the military and VA are providing medical care to injured individuals who might have died in previous conflicts.

Given the possible effects of explosions on the human body, it is not surprising that blast injuries are often “polytraumatic.” Injured body systems and structures include auditory/vestibular, eye, orbit, face, respiratory, digestive, circulatory, central nervous system, renal/urinary tract, extremity, soft tissue, mental health, and pain. Particularly common is Traumatic Brain Injury (TBI). It has been estimated that over 60% of blast-injuries result in TBI and TBI has been labeled the "signature injury" in the Global War on Terror (GWOT). Consequently, best practice for polytrauma requires a focus on TBI in the context of other injuries.

Based on Needs Assessment Studies, input from Executive Committee members and VA senior staff, the Polytrauma and Blast-Related Injuries (PT/BRI) QUERI has identified four priorities areas for research – (1) the development of data systems for tracking patients and monitoring health care services needs and patient outcomes, (2) the development of tools and strategies for maximizing care coordination as combat injured patients navigate within and across care systems, (3) the development of interventions and tools to support family members who find themselves in care-giving roles and to facilitate their meaningful involvement in the recovery process, and (4) screening and evaluation for high prevalent co-morbidities. PT/BRI QUERI investigators are working on projects to improve outcomes in each of these high priority areas.