{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:46:16Z","timestamp":1791963976696,"version":"4.3.4"},"reference-count":62,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Blast\u2010 and penetrating\u2010mechanism traumatic brain injury (TBI) is increasingly prevalent in settings affected by conflict and explosive violence, including among local casualties in environments where neurosurgical infrastructure, advanced imaging, and critical care resources may be limited or absent. No protocols or guidelines comprehensively address the full spectrum of TBI from blast and penetrating mechanisms across variable resource levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Explosive Weapons Trauma Care Collective (EXTRACCT) conducted a targeted narrative literature review across key clinical domains, including initial assessment, hemodynamic and airway management, medical treatment of intracranial hypertension, noninvasive neuromonitoring, surgical decision\u2010making, and interfacility transport. Searches were performed in PubMed and supplemented by military, penetrating and trauma system clinical practice guidelines (Joint Trauma System, Brain Trauma Foundation, TCCC). Evidence was synthesized by a multidisciplinary authorship team and consensus was achieved through iterative expert review, following the AGREE II framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This document provides stratified recommendations across variable resource contexts. Key recommendations include: early physiological stabilization with avoidance of hypotension and hypoxia; structured neurological assessment using postresuscitation GCS and pupillometry; noncontrast head CT as the primary imaging modality, with CT angiography for penetrating TBI and high\u2010risk blunt mechanisms; hyperosmolar therapy as first\u2010line treatment for intracranial hypertension; evidence\u2010based sedation, analgesia, and neuromuscular blockade protocols; noninvasive multimodal neuromonitoring when invasive ICP monitoring is unavailable; surgical thresholds for decompressive craniectomy and craniotomy; and standardized transport protocols to minimize secondary brain injury during interfacility transfer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This document addresses a critical gap in context\u2010appropriate blast\u2010TBI management for settings with variable resource availability. Strict control of basic physiological parameters, structured clinical decision\u2010making, and early transfer to neurosurgical care remain the primary determinants of outcome in resource\u2010limited environments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70522","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:33:36Z","timestamp":1788240816000},"page":"3074-3091","source":"Crossref","is-referenced-by-count":0,"title":["Explosive Weapons Trauma Care Collective (EXTRACCT) Blast Injury Clinical Practice Guideline: Traumatic Brain Injury From Blast and Penetrating Mechanisms in Settings With Variable Resource Availability"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8931-3254","authenticated-orcid":false,"given":"Andres M.","family":"Rubiano","sequence":"first","affiliation":[{"name":"Neuroscience Institute El Bosque University  Bogot\u00e1 Colombia"},{"name":"MEDITECH Foundation  Cali Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5747-9844","authenticated-orcid":false,"given":"Laura M.","family":"Loaiza\u2010Cardona","sequence":"additional","affiliation":[{"name":"MEDITECH Foundation  Cali Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4033-1985","authenticated-orcid":false,"given":"Ali","family":"Msheik","sequence":"additional","affiliation":[{"name":"Neurosurgery Resident Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1751-0732","authenticated-orcid":false,"given":"Andr\u00e9s Salazar","family":"Restrepo","sequence":"additional","affiliation":[{"name":"MEDITECH Foundation  Cali Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1446-0636","authenticated-orcid":false,"given":"Santiago","family":"Cardona\u2010Collazos","sequence":"additional","affiliation":[{"name":"MEDITECH Foundation  Cali Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6536-2035","authenticated-orcid":false,"given":"Andrii","family":"Sirko","sequence":"additional","affiliation":[{"name":"Head of the Center for Cerebral Neurosurgery Communal Enterprise Dnipropetrovsk Regional Clinical Hospital Named After I.I. Mechnikov  Dnipro Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2817-0194","authenticated-orcid":false,"given":"Ruben","family":"Peralta","sequence":"additional","affiliation":[{"name":"Trauma Surgery Hamad Medical Corporation  Doha Qatar"},{"name":"Department of Surgery School of Medicine Universidad Nacional Pedro Henr\u00edquez Urena  Santo Domingo Dominican Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the EXTRACCT Clinical Practice Guidelines Collaboration","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_2_21_2_1","doi-asserted-by":"publisher","DOI":"10.7205\/milmed\u2010d\u201009\u201000238"},{"key":"e_1_2_21_3_1","doi-asserted-by":"crossref","unstructured":"J. K.Zhang Blast\u2010Related Traumatic Brain Injuries Secondary to Thermobaric Explosives: Implications for the War in Ukraine https:\/\/doi.org\/10.1016\/j.wneu.2022.08.073.","DOI":"10.1016\/j.wneu.2022.08.073"},{"key":"e_1_2_21_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc2997"},{"key":"e_1_2_21_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2020.09.167"},{"key":"e_1_2_21_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2001.114906"},{"key":"e_1_2_21_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1049023X22000747"},{"key":"e_1_2_21_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.112.4.e280"},{"key":"e_1_2_21_9_1","doi-asserted-by":"crossref","unstructured":"K. H.Taber Blast\u2010Related Traumatic Brain Injury: What is Known? https:\/\/doi.org\/10.1176\/jnp.2006.18.2.141.","DOI":"10.1176\/jnp.2006.18.2.141"},{"key":"e_1_2_21_10_1","doi-asserted-by":"publisher","DOI":"10.3109\/02699052.2011.580313"},{"key":"e_1_2_21_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(13)70161\u20103"},{"key":"e_1_2_21_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/wjs.12644"},{"key":"e_1_2_21_13_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090449"},{"key":"e_1_2_21_14_1","unstructured":"American College of Surgeons Advanced Trauma Life Support\u00ae Student Course Manual 10th ed.American College of Surgeons."},{"key":"e_1_2_21_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010019\u20100270\u20101"},{"key":"e_1_2_21_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usae298"},{"key":"e_1_2_21_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2017.5599"},{"key":"e_1_2_21_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bas.2026.106046"},{"key":"e_1_2_21_19_1","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000001432"},{"key":"e_1_2_21_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11739\u2010021\u201002838\u20101"},{"key":"e_1_2_21_21_1","doi-asserted-by":"publisher","DOI":"10.3109\/02688697.2015.1096905"},{"key":"e_1_2_21_22_1","unstructured":"Committee on Tactical Combat Casualty Care.Tactical Combat Casualty Care (TCCC) Guidelines 2024.2024 https:\/\/tccc.org.ua\/files\/downloads\/clinical\u2010guidelines\u20102024\u2010en.pdf."},{"key":"e_1_2_21_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2016.03.015"},{"key":"e_1_2_21_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0810625"},{"key":"e_1_2_21_25_1","volume-title":"Best Practices Guidelines: The Management of Traumatic Brain Injury","author":"Manley G. T."},{"key":"e_1_2_21_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000058130.30490.5D"},{"key":"e_1_2_21_27_1","doi-asserted-by":"publisher","DOI":"10.3109\/02699052.2012.743182"},{"key":"e_1_2_21_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010014\u20102874\u20107"},{"key":"e_1_2_21_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049\u2010018\u20100559\u20101"},{"key":"e_1_2_21_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.12439"},{"key":"e_1_2_21_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awz290"},{"key":"e_1_2_21_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.23783"},{"key":"e_1_2_21_33_1","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000003738"},{"key":"e_1_2_21_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(19)32233\u20100"},{"key":"e_1_2_21_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(10)60835\u20105"},{"key":"e_1_2_21_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13582"},{"key":"e_1_2_21_37_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2008.0729"},{"key":"e_1_2_21_38_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199801013380104"},{"key":"e_1_2_21_39_1","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.35.10.1406"},{"key":"e_1_2_21_40_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199008233230801"},{"key":"e_1_2_21_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528\u20101167.2011.03235.x"},{"key":"e_1_2_21_42_1","unstructured":"K.Berger D. E.Swor andC.Press Emergency Neurological Life Support Status Epilepticus Protocol Version 5.0 https:\/\/www.neurocriticalcare.org\/Portals\/0\/ENLS%205.0\/ENLS%205.0%20Protocol%20\u2010%20SE.pdf."},{"key":"e_1_2_21_43_1","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco\u20102023\u2010001304"},{"key":"e_1_2_21_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usy077"},{"key":"e_1_2_21_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000004383"},{"key":"e_1_2_21_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002830"},{"key":"e_1_2_21_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000004921"},{"key":"e_1_2_21_48_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012639.pub2"},{"key":"e_1_2_21_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.11.079"},{"key":"e_1_2_21_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010024\u201007756\u20102"},{"key":"e_1_2_21_51_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2021.0342"},{"key":"e_1_2_21_52_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028\u2010023\u201001927\u20107"},{"key":"e_1_2_21_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2023.120853"},{"key":"e_1_2_21_54_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010023\u201045834\u20105"},{"key":"e_1_2_21_55_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028\u2010025\u201002273\u20106"},{"key":"e_1_2_21_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.01.005"},{"key":"e_1_2_21_57_1","article-title":"Emergency Life\u2010Saving Cranial Procedures by Non\u2010Neurosurgeons in Deployed Setting","author":"Porensky P.","year":"2025","journal-title":"Joint Trauma System CPG"},{"key":"e_1_2_21_58_1","doi-asserted-by":"publisher","DOI":"10.3171\/2024.10.JNS241938"},{"key":"e_1_2_21_59_1","doi-asserted-by":"publisher","DOI":"10.3171\/2023.12.JNS232070"},{"key":"e_1_2_21_60_1","doi-asserted-by":"publisher","DOI":"10.3171\/2024.6.JNS24852"},{"key":"e_1_2_21_61_1","doi-asserted-by":"publisher","DOI":"10.3171\/2025.8.JNS251191"},{"key":"e_1_2_21_62_1","doi-asserted-by":"publisher","DOI":"10.1177\/1179069519872213"},{"key":"e_1_2_21_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010013\u20102938\u20104"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70522","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70522","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70522","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:01:07Z","timestamp":1791961267000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70522"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":62,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/wjs.70522"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70522","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]}}}