Epidemiology of Blast Neurotrauma: A Meta-analysis of Blast Injury Patterns in the Military and Civilian Populations

World Neurosurg. 2021 Feb:146:308-314.e3. doi: 10.1016/j.wneu.2020.11.093. Epub 2020 Nov 25.


Background: Mass casualty incidents (MCIs) due to bombing-related terrorism remain an omnipresent threat to our global society. The aim of this study was to elucidate differences in blast injury patterns between military and civilian victims affected by terrorist bombings.

Methods: An analysis of the Global Terrorism Database (GTD) and a PubMed literature search of casualty reports of bombing attacks from 2010-2020 was performed (main key words: blast injuries/therapy, terrorism, military personnel) with key epidemiological and injury pattern data extracted and statistically analyzed.

Results: Demographic analysis of casualties revealed that military casualties tend to be younger and predominantly male (P < 0.05) compared with civilians. Military casualties also reported higher amounts of head/neck injury (P < 0.01) compared with civilians. The proportion of instantaneous fatalities along with injuries affecting the thoracoabdominal and extremity regions remained approximately equal across both groups.

Conclusions: Though the increased number of head/neck injuries was unexpected, we also found that the number of nonlethal head injuries also increased, predicating that more military blast neurotrauma patients survived their injuries. These data can be used to increase blast MCI preparation and education throughout the international neurosurgical community.

Keywords: Blast injury; Bombings; Disaster epidemiology; Disaster neurosurgery; Neurotrauma; Terrorism.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Blast Injuries / complications
  • Blast Injuries / epidemiology*
  • Brain Injuries, Traumatic / complications
  • Brain Injuries, Traumatic / epidemiology*
  • Humans
  • Mass Casualty Incidents
  • Military Personnel