{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T01:33:46Z","timestamp":1787621626874,"version":"build-2736575974"},"reference-count":23,"publisher":"SAGE Publications","issue":"1-2","license":[{"start":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T00:00:00Z","timestamp":1672358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>Previous research has shown that injuries to the head and neck were prevalent in 73% of all mounted fatalities of underbody blast. The mechanisms that cause such injuries to the central nervous system (CNS) are not yet known. The aim of this study was to identify the head and spinal injuries in fatalities due to underbody blast (UBB) and then develop hypotheses on the causative mechanisms. All U.K. military fatalities from UBB with an associated head injury that occurred during 2007\u20132013 in the Iraq and Afghanistan conflicts were identified retrospectively. Computed tomography post-mortems (CTPMs) were interrogated for injuries to the head, neck, and spine. All injuries were documented and classified using a radiology classification. Pearson's chi-square and Fisher's exact tests were used to show a relationship between variables and form a hypothesis for injury mechanisms. There were 50 fatalities from UBB with an associated head injury. Of these, 46 had complete CTPMs available for analysis. Chi-square and Fisher's exact tests showed a relationship between lateral ventricle blood and injuries to the abdomen and thorax.<\/jats:p>\n                  <jats:p>\n                    Five partially overlapping injury constellations were identified:\n                    <jats:list list-type=\"simple\">\n                      <jats:list-item>\n                        <jats:label>1.<\/jats:label>\n                        <jats:p>multiple-level spinal injury with skull fracture and brainstem injury,<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:label>2.<\/jats:label>\n                        <jats:p>peri-mesencephalic hemorrhage,<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:label>3.<\/jats:label>\n                        <jats:p>spinal and brainstem injury,<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:label>4.<\/jats:label>\n                        <jats:p>parenchymal contusions with injury to C0\u2013C1, and<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:label>5.<\/jats:label>\n                        <jats:p>an \u201ceggshell\u201d pattern of fractures from direct impact.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:p>\n                  <jats:p>These injury constellations can now be used to propose injury mechanisms to develop mitigation strategies or clinical treatments.<\/jats:p>","DOI":"10.1089\/neu.2021.0400","type":"journal-article","created":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T05:33:08Z","timestamp":1659504788000},"page":"141-147","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Injuries in Underbody Blast Fatalities: Identification of Five Distinct Mechanisms of Head Injury"],"prefix":"10.1177","volume":"40","author":[{"given":"Emily","family":"Ashworth","sequence":"first","affiliation":[{"name":"Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Baxter","sequence":"additional","affiliation":[{"name":"Royal Centre for Defence Medicine, Birmingham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain","family":"Gibb","sequence":"additional","affiliation":[{"name":"Centre for Defence Radiology, Royal Centre for Defence Medicine, Birmingham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Wilson","sequence":"additional","affiliation":[{"name":"Imperial Neurotrauma Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M.J.","family":"Bull","sequence":"additional","affiliation":[{"name":"Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,12,30]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000057151.02906.27"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.319.5862.406"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","unstructured":"Wade AL Dye JL Mohrle CR et al. Head face and neck injuries during Operation Iraqi Freedom II: results from the US Navy and Marine Corps Combat Trauma Registry. 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The diagnosis of head injury requires a classification based on computed axial tomography. 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