title: A systematic review of military head injuries.
abstract: BACKGROUND
  This commissioned review discusses military head injuries caused by non-ballistic impacts, penetrating fragments and bullets (including parts of bullets) and behind helmet blunt trauma (BHBT).
  
  
  METHODS
  A systematic review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. The openly accessible literature was reviewed to investigate military head injuries and their severity.
  
  
  RESULTS
  Fifty-four sources were identified that included pertinent openly accessible information relevant to this topic. Limited injury data exist for non-ballistic head injuries for UK forces, although some international data exist for parachutists. The majority of fatal head injuries are due to projectiles penetrating through the face rather than through the area of the head covered by the helmet. Penetrating head injuries are primarily caused by fragments, but helmets are more commonly perforated by high-energy rifle bullets than by fragments. No reports of a BHBT injury have been located in the literature.
  
  
  CONCLUSIONS
  The description of body segment varies among articles and this makes comparisons among datasets difficult. There is a lack of detail regarding the precise position and severity of injuries, and long-term outcome for casualties. It is demonstrated that wearing military helmets reduces fatalities on and off the battlefield. The risk of BHBT injuries is widely referred to, but evidence of their occurrence is not provided by the authors that describe the risk of BHBT occurring. Further research into the causes and severity of head injuries would be useful for designers of military helmets and other associated personal protective equipment, particularly as advances in materials technology means lighter, thinner and more protective helmets are achievable.
authors.affiliation: Impact and Armour Group, Centre for Defence Engineering, Cranfield University at the Defence Academy of the United Kingdom, Shrivenham, UK.
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Carr
authors.affiliation: Defence Equipment and Support, UK Ministry of Defence, Bristol, UK.
authors.forename: E
authors.initials: E
authors.lastname: Lewis
authors.affiliation: Impact and Armour Group, Centre for Defence Engineering, Cranfield University at the Defence Academy of the United Kingdom, Shrivenham, UK.
authors.forename: I
authors.initials: I
authors.lastname: Horsfall
mesh_terms: D006259:Craniocerebral Trauma / Q000517:prevention & control*; D006260:Head Protective Devices; D006801:Humans; D008889:Military Personnel; D006113:United Kingdom
keywords: cause of injury; head injuries; wound ballistics