title: Traumatic brain injury in modern war.
abstract: OBJECTIVE
  To review the emerging literature on traumatic brain injury (TBI) caused by explosive blast.
  
  
  RESULTS
  Efforts are underway to understand how explosive blast injures brain, what is the clinical presentation and how best to manage it. A major way blast injures brain is from detonation pressure waves coupling to a victim's head leading to brain deformation. The effect of other explosion-related elements is unknown. Because scientific insights take time to develop but injuries are occurring now, the military adopts existing civilian standard of care practices developed for similar diseases, such as the Guidelines for the Management of Severe Traumatic Brain Injury developed mainly for closed head TBI. When these do not exist, the military creates them, such as the Veterans Administration and Department of Defense Clinical Practice Guidelines for Concussion/Mild TBI. Another treatment advance is the creation of the first large system-wide approach to diagnosis and clinical management of TBI, which begins at the site of injury and extends through both the military and the Veterans' Administration medical care systems.
  
  
  CONCLUSIONS
  Explosive blast TBI is being addressed at all levels - basic research through clinical care. New clinical practice guidelines are being used in a standardized system-wide approach.
authors.affiliation: Department of Neurology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland, USA. gling@usuhs.mil
authors.forename: Geoffrey S F
authors.initials: GS
authors.lastname: Ling
authors.forename: James M
authors.initials: JM
authors.lastname: Ecklund
mesh_terms: D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000473:pathology; D001930:Brain Injuries / Q000145:classification / Q000473:pathology*; D005107:Explosions; D053834:Explosive Agents; D006801:Humans; D054542:Iraq War, 2003-2011; D008887:Military Medicine; D010346:Patient Care Management; D014857:Warfare
chemical_list: D053834:Explosive Agents