{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T19:13:28Z","timestamp":1771528408235,"version":"3.50.1"},"reference-count":101,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish Defense material"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Traumatic brain injury (TBI) remains a leading cause of morbidity among military personnel, despite improved personal protective equipment. Although modern combat helmets effectively prevent penetration and skull fractures, their ability to mitigate behind-helmet blunt trauma (BHBT) and primary blast-induced TBI (bTBI) is less clear. This review evaluates combat helmet protection considering biomechanical, medical, and operational evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A structured scoping literature review was conducted according to the SANRA framework. Searches were performed in PubMed, Scopus, and SciFinder using combinations of terms related to \u201ccombat helmet,\u201d \u201cblunt trauma,\u201d \u201cballistic impact,\u201d \u201cblast exposure,\u201d and \u201ctraumatic brain injury.\u201d Peer-reviewed studies, experimental reports, and regulatory standards (NIJ, NATO STANAG) were included. Data were synthesized thematically by injury mechanism, protection metric, and helmet design characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ballistic helmets significantly reduce skull fractures and contusions but provide limited protection against diffuse axonal injury and blast overpressure. Rotational acceleration correlates strongly with predicted strain and mild TBI, yet is not incorporated into current standards. Pad stiffness, fit, and coverage strongly influence both ballistic and blast protection, creating trade-offs between impact absorption and blast under wash. Finite element models and biomarker studies show complementary value but require in vivo validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Current helmet standards insufficiently address complex threat biomechanics. Future developments should integrate multidimensional metrics, linear and rotational kinematics, strain thresholds, and sensor-derived field data, while balancing tactical functionality with neurobiological protection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag047","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T12:43:52Z","timestamp":1769604232000},"source":"Crossref","is-referenced-by-count":0,"title":["Reassessing Combat Helmet Protection Against Blunt and Blast Threats: A Structured Scoping Review"],"prefix":"10.1093","author":[{"given":"Sebastian","family":"Thams","sequence":"first","affiliation":[{"name":"Section for Experimental Traumatology, Department of Neuroscience, Karolinska Institutet , Stockholm, 17177,","place":["Sweden"]},{"name":"Department of Neurology, Karolinska University Hospital , Stockholm, 17176,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattias K","family":"Sk\u00f6ld","sequence":"additional","affiliation":[{"name":"Section for Experimental Traumatology, Department of Neuroscience, Karolinska Institutet , Stockholm, 17177,","place":["Sweden"]},{"name":"Department of Medical Sciences, Section of Neurosurgery, Uppsala University , Uppsala, 75310,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulf P","family":"Arborelius","sequence":"additional","affiliation":[{"name":"Section for Experimental Traumatology, Department of Neuroscience, Karolinska Institutet , Stockholm, 17177,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2372-6114","authenticated-orcid":false,"given":"Mattias","family":"G\u00fcnther","sequence":"additional","affiliation":[{"name":"Section for Experimental Traumatology, Department of Neuroscience, Karolinska Institutet , Stockholm, 17177,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"2026021913192894700_usag047-B1","doi-asserted-by":"publisher","first-page":"e313","DOI":"10.1093\/milmed\/usab108","article-title":"Review of military casualties in modern conflicts\u2014the re-emergence of casualties from armored warfare","volume":"187","author":"Khorram-Manesh","year":"2022","journal-title":"Mil Med"},{"key":"2026021913192894700_usag047-B2","doi-asserted-by":"publisher","first-page":"e774","DOI":"10.1093\/milmed\/usz431","article-title":"Mortality and functional outcome predictors in Combat-Related penetrating brain injury treatment in a specialty civilian medical facility","volume":"185","author":"Sirko","year":"2020","journal-title":"Mil Med"},{"key":"2026021913192894700_usag047-B3","volume-title":"Review of the Department of Defense Test Protocols for Combat Helmets","year":"2014"},{"key":"2026021913192894700_usag047-B4","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1001\/jamaneurol.2014.1114","article-title":"Prospectively assessed clinical outcomes in concussive blast vs. nonblast traumatic brain injury among evacuated US military personnel","volume":"71","author":"Mac Donald","year":"2014","journal-title":"JAMA Neurol"},{"key":"2026021913192894700_usag047-B5","doi-asserted-by":"publisher","first-page":"1179069519872213","DOI":"10.1177\/1179069519872213","article-title":"Blast-Related traumatic brain injury: current concepts and research considerations","volume":"13","author":"Bryden","year":"2019","journal-title":"J Exp Neurosci"},{"key":"2026021913192894700_usag047-B6","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/S1474-4422(13)70161-3","article-title":"Blast-related traumatic brain injury","volume":"12","author":"Rosenfeld","year":"2013","journal-title":"Lancet Neurol"},{"key":"2026021913192894700_usag047-B7","doi-asserted-by":"publisher","first-page":"829","DOI":"10.3171\/2024.6.JNS24852","article-title":"Wartime penetrating traumatic brain injury of the anterior skull base involving the paranasal sinuses: a single-center, first-year experience from Dnipro, Ukraine","volume":"142","author":"Sirko","year":"2025","journal-title":"J Neurosurg"},{"key":"2026021913192894700_usag047-B8","doi-asserted-by":"publisher","first-page":"431","DOI":"10.3171\/2024.10.JNS241938","article-title":"Early multimodal neurointerventional and neurosurgical management of penetrating craniocerebral injuries: wartime experience from Ukraine","volume":"143","author":"Sirko","year":"2025","journal-title":"J Neurosurg"},{"key":"2026021913192894700_usag047-B9","doi-asserted-by":"publisher","first-page":"2495","DOI":"10.21595\/jve.2015.16497","article-title":"A study on protective performance of bullet-proof helmet under impact loading","volume":"18","author":"Cai","year":"2016","journal-title":"J Vibroeng"},{"key":"2026021913192894700_usag047-B10","doi-asserted-by":"publisher","first-page":"6444","DOI":"10.1007\/s10853-023-08441-3","article-title":"Review: a developmental perspective on protective helmets","volume":"58","author":"Singh","year":"2023","journal-title":"J Mater Sci"},{"key":"2026021913192894700_usag047-B11","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1111\/1556-4029.12570","article-title":"Injuries of the head from backface deformation of ballistic protective helmets under ballistic impact","volume":"60","author":"Rafaels","year":"2015","journal-title":"J Forensic Sci"},{"key":"2026021913192894700_usag047-B12","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1097\/00005373-200011000-00021","article-title":"Consequences of nonpenetrating projectile impact on a protected head: study of rear effects of protections","volume":"49","author":"Sarron","year":"2000","journal-title":"J Trauma"},{"key":"2026021913192894700_usag047-B13","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1136\/jramc-2015-000600","article-title":"A systematic review of military head injuries","volume":"163","author":"Carr","year":"2017","journal-title":"J R Army Med Corps"},{"key":"2026021913192894700_usag047-B14","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1080\/10255842.2011.597353","article-title":"Role of helmet in the mechanics of shock wave propagation under blast loading conditions","volume":"15","author":"Ganpule","year":"2012","journal-title":"Comput Methods Biomech Biomed Engin"},{"key":"2026021913192894700_usag047-B15","doi-asserted-by":"publisher","first-page":"e06990","DOI":"10.1016\/j.heliyon.2021.e06990","article-title":"Testing the blast response of foam inserts for helmets","volume":"7","author":"Bloodworth-Race","year":"2021","journal-title":"Heliyon"},{"key":"2026021913192894700_usag047-B16","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1093\/milmed\/usaa317","article-title":"Prevention of blast-induced auditory injury using 3D printed helmet and hearing protection Device - A preliminary study on biomechanical modeling and animal","volume":"186","author":"Jiang","year":"2021","journal-title":"Mil Med"},{"key":"2026021913192894700_usag047-B17","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.compstruct.2013.02.014","article-title":"Ballistic helmets - Their design, materials, and performance against traumatic brain injury","volume":"101","author":"Kulkarni","year":"2013","journal-title":"Compos Struct"},{"key":"2026021913192894700_usag047-B18","doi-asserted-by":"publisher","first-page":"321ra6","DOI":"10.1126\/scitranslmed.aaa9585","article-title":"Repetitive blast exposure in mice and combat veterans causes persistent cerebellar dysfunction","volume":"8","author":"Meabon","year":"2016","journal-title":"Sci Transl Med"},{"key":"2026021913192894700_usag047-B19","doi-asserted-by":"publisher","first-page":"89","DOI":"10.3389\/fneur.2015.00089","article-title":"When physics meets biology: low and high-velocity penetration, blunt impact, and blast injuries to the brain","volume":"6","author":"Young","year":"2015","journal-title":"Front Neurol"},{"key":"2026021913192894700_usag047-B20","doi-asserted-by":"publisher","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann Intern Med"},{"key":"2026021913192894700_usag047-B21","doi-asserted-by":"publisher","first-page":"4002","DOI":"10.1038\/s41598-022-05772-0","article-title":"Extracellular vesicle neurofilament light is elevated within the first 12-months following traumatic brain injury in a U.S military population","volume":"12","author":"Guedes","year":"2022","journal-title":"Sci Rep"},{"key":"2026021913192894700_usag047-B22","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/B978-0-444-52892-6.00004-0","article-title":"The neuropathology of traumatic brain injury","volume":"127","author":"McKee","year":"2015","journal-title":"Handb Clin Neurol"},{"key":"2026021913192894700_usag047-B23","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1016\/j.jmbbm.2011.06.007","article-title":"Computation of axonal elongation in head trauma finite element simulation","volume":"4","author":"Chatelin","year":"2011","journal-title":"J Mech Behav Biomed Mater"},{"key":"2026021913192894700_usag047-B24","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1002\/ana.410120611","article-title":"Diffuse axonal injury and traumatic coma in the primate","volume":"12","author":"Gennarelli","year":"1982","journal-title":"Ann Neurol"},{"key":"2026021913192894700_usag047-B25","doi-asserted-by":"publisher","first-page":"15","DOI":"10.3389\/fbioe.2013.00015","article-title":"Why most traumatic brain injuries are not caused by linear acceleration but skull fractures are","volume":"1","author":"Kleiven","year":"2013","journal-title":"Front Bioeng Biotechnol"},{"key":"2026021913192894700_usag047-B26","doi-asserted-by":"publisher","first-page":"e55823","DOI":"10.1371\/journal.pone.0055823","article-title":"Cerebellar white matter abnormalities following primary blast injury in US military personnel","volume":"8","author":"Mac Donald","year":"2013","journal-title":"PLoS One"},{"key":"2026021913192894700_usag047-B27","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1056\/NEJMoa1008069","article-title":"Detection of blast-related traumatic brain injury in U.S. military personnel","volume":"364","author":"Mac Donald","year":"2011","journal-title":"N Engl J Med"},{"key":"2026021913192894700_usag047-B28","doi-asserted-by":"publisher","DOI":"10.1186\/s40478-022-01435-3","article-title":"Purkinje cell vulnerability induced by diffuse traumatic brain injury is linked to disruption of long-range neuronal circuits","volume":"10","author":"\u00d6zen","year":"2022","journal-title":"Acta Neuropathol Commun"},{"key":"2026021913192894700_usag047-B29","doi-asserted-by":"publisher","first-page":"14605","DOI":"10.1038\/s41598-022-17967-6","article-title":"A biomechanical-based approach to scale blast-induced molecular changes in the brain","volume":"12","author":"Rubio","year":"2022","journal-title":"Sci Rep"},{"key":"2026021913192894700_usag047-B30","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1148\/rg.2021200189","article-title":"CT of skull base fractures: Classification systems, complications, and management","volume":"41","author":"Dreizin","year":"2021","journal-title":"Radiographics"},{"key":"2026021913192894700_usag047-B31","article-title":"Nils lubbe, editor craniofacial injuries for helmeted and unhelmeted bicyclists in Germany","author":"Shiyang Meng FG","year":"2023","journal-title":"IRCOBI"},{"key":"2026021913192894700_usag047-B32","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1089\/neu.2021.0321","article-title":"Diffuse traumatic injury in the mouse disrupts Axon-Myelin integrity in the cerebellum","volume":"39","author":"Ozen","year":"2022","journal-title":"J Neurotrauma"},{"key":"2026021913192894700_usag047-B33","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.1089\/neu.2015.4272","article-title":"Ultrastructure of diaschisis lesions after traumatic brain injury","volume":"33","author":"Wiley","year":"2016","journal-title":"J Neurotrauma"},{"key":"2026021913192894700_usag047-B34","first-page":"134ra60","article-title":"Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model","volume":"4","author":"Goldstein","year":"2012","journal-title":"Sci Transl Med"},{"key":"2026021913192894700_usag047-B35","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1227\/01.NEU.0000175725.75780.DD","article-title":"Association between recurrent concussion and late-life cognitive impairment in retired professional football players","volume":"57","author":"Guskiewicz","year":"2005","journal-title":"Neurosurgery"},{"key":"2026021913192894700_usag047-B36","doi-asserted-by":"publisher","first-page":"3235","DOI":"10.1089\/neu.2021.0062","article-title":"Epidemiology of chronic effects of traumatic brain injury","volume":"38","author":"Haarbauer-Krupa","year":"2021","journal-title":"J Neurotrauma"},{"key":"2026021913192894700_usag047-B37","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1227\/01.neu.0000149008.73513.44","article-title":"Temporal window of vulnerability to repetitive experimental concussive brain injury","volume":"56","author":"Longhi","year":"2005","journal-title":"Neurosurgery"},{"key":"2026021913192894700_usag047-B38","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1038\/nrneurol.2013.29","article-title":"Chronic neuropathologies of single and repetitive TBI: substrates of dementia?","volume":"9","author":"Smith","year":"2013","journal-title":"Nat Rev Neurol"},{"key":"2026021913192894700_usag047-B39","doi-asserted-by":"publisher","first-page":"e771","DOI":"10.1093\/milmed\/usab394","article-title":"Repetitive low-level blast exposure and neurocognitive effects in army ranger mortarmen","volume":"188","author":"Woodall","year":"2023","journal-title":"Mil Med"},{"key":"2026021913192894700_usag047-B40","doi-asserted-by":"publisher","first-page":"e1154","DOI":"10.1093\/milmed\/usad429","article-title":"Significant mitigation of blast overpressure exposure during training by adjustment of body position as demonstrated with field data","volume":"189","author":"Wiri","year":"2024","journal-title":"Mil Med"},{"key":"2026021913192894700_usag047-B41","doi-asserted-by":"publisher","first-page":"409","DOI":"10.7150\/ijms.8079","article-title":"Dynamic response due to behind helmet blunt trauma measured with a human head surrogate","volume":"11","author":"Freitas","year":"2014","journal-title":"Int J Med Sci"},{"key":"2026021913192894700_usag047-B42","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.ijimpeng.2015.12.010","article-title":"Behind helmet blunt trauma induced by ballistic impact: a computational model","volume":"91","author":"Li","year":"2016","journal-title":"Int J Impact Eng"},{"key":"2026021913192894700_usag047-B43","doi-asserted-by":"publisher","DOI":"10.1115\/1.4031095","article-title":"Modeling of advanced combat helmet under ballistic impact","volume":"82","author":"Li","year":"2015","journal-title":"J Appl Mech-T Asme"},{"key":"2026021913192894700_usag047-B44","doi-asserted-by":"publisher","first-page":"2348064","DOI":"10.1155\/2020\/2348064","article-title":"Study on behind helmet blunt trauma caused by high-speed bullet","volume":"2020","author":"Cai","year":"2020","journal-title":"Appl Bionics Biomech"},{"key":"2026021913192894700_usag047-B45","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.compstruct.2018.05.076]","article-title":"Relevant factors in the design of composite ballistic helmets","volume":"201","author":"Palomar","year":"2018","journal-title":"Compos Struct"},{"key":"2026021913192894700_usag047-B46","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.ijimpeng.2012.06.003","article-title":"Performance of an advanced combat helmet with different interior cushioning systems in ballistic impact: Experiments and finite element simulations","volume":"50","author":"Bin Tan","year":"2012","journal-title":"Int J Impact Eng"},{"key":"2026021913192894700_usag047-B47","doi-asserted-by":"publisher","first-page":"E1918","DOI":"10.1093\/milmed\/usab547","article-title":"Influence of friction at the Head-Helmet interface on advanced combat helmet (ACH) blunt impact kinematic performance","volume":"188","author":"York","year":"2023","journal-title":"Mil Med"},{"key":"2026021913192894700_usag047-B48","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1016\/j.ijimpeng.2005.08.001","article-title":"Evaluation of head response to ballistic helmet impacts using the finite element method","volume":"34","author":"Aare","year":"2007","journal-title":"Int J Impact Eng"},{"key":"2026021913192894700_usag047-B49","author":"Halldin","year":"2013"},{"key":"2026021913192894700_usag047-B50","doi-asserted-by":"publisher","first-page":"59","DOI":"10.3722\/cadaps.2010.59-73","article-title":"Simulation-based assessment of rear effect to ballistic helmet impact","volume":"7","author":"Yang","year":"2010","journal-title":"Comput Aided Design Appl"},{"key":"2026021913192894700_usag047-B51","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1007\/s11517-016-1536-3","article-title":"Effect of helmet liner systems and impact directions on severity of head injuries sustained in ballistic impacts: a finite element (FE) study","volume":"55","author":"Tse","year":"2017","journal-title":"Med Biol Eng Comput"},{"key":"2026021913192894700_usag047-B52","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1080\/02699052.2019.1566834","article-title":"The effect of impact location on brain strain","volume":"33","author":"Tiernan","year":"2019","journal-title":"Brain Inj"},{"key":"2026021913192894700_usag047-B53","doi-asserted-by":"publisher","DOI":"10.1002\/cnm.2782","article-title":"Evaluation of brain tissue responses because of the underwash overpressure of helmet and faceshield under blast loading","volume":"33","author":"Sarvghad-Moghaddam","year":"2017","journal-title":"Int J Numer Method Biomed Eng"},{"key":"2026021913192894700_usag047-B54","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.3389\/fneur.2019.01015","article-title":"A comprehensive review of experimental rodent models of repeated blast TBI","volume":"10","author":"Skotak","year":"2019","journal-title":"Front Neurol"},{"key":"2026021913192894700_usag047-B55","doi-asserted-by":"publisher","first-page":"1579","DOI":"10.1007\/s10439-022-02936-x","article-title":"Protective performance of helmets and goggles in mitigating brain biomechanical response to primary blast exposure","volume":"50","author":"Yu","year":"2022","journal-title":"Ann Biomed Eng"},{"key":"2026021913192894700_usag047-B56","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1136\/jramc-2018-001123","article-title":"UK military helmet design and test methods","volume":"166","author":"Carr","year":"2020","journal-title":"BMJ Mil Health"},{"key":"2026021913192894700_usag047-B57","doi-asserted-by":"publisher","first-page":"2716","DOI":"10.1007\/s10439-021-02785-0","article-title":"A new assessment of bicycle helmets: the brain injury mitigation effects of new technologies in oblique impacts","volume":"49","author":"Abayazid","year":"2021","journal-title":"Ann Biomed Eng"},{"key":"2026021913192894700_usag047-B58","doi-asserted-by":"publisher","first-page":"16061","DOI":"10.1038\/s41598-022-20533-9","article-title":"Study on protective performance and gradient optimization of helmet foam liner under bullet impact","volume":"12","author":"Huang","year":"2022","journal-title":"Sci Rep"},{"key":"2026021913192894700_usag047-B59","doi-asserted-by":"publisher","first-page":"0310061","DOI":"10.1115\/1.4046393","article-title":"Head rotational kinematics, tissue deformations, and their relationships to the acute traumatic axonal injury","volume":"142","author":"Hajiaghamemar","year":"2020","journal-title":"J Biomech Eng"},{"key":"2026021913192894700_usag047-B60","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1007\/s10439-011-0414-2","article-title":"Mild traumatic brain injury predictors based on angular accelerations during impacts","volume":"40","author":"Kimpara","year":"2012","journal-title":"Ann Biomed Eng"},{"key":"2026021913192894700_usag047-B61","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1038\/s41598-021-03744-4","article-title":"Blast-induced axonal degeneration in the rat cerebellum in the absence of head movement","volume":"12","author":"Bishop","year":"2022","journal-title":"Sci Rep"},{"key":"2026021913192894700_usag047-B62","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1007\/s10439-022-03085-x","article-title":"Concussion prone scenarios: a multi-dimensional exploration in impact directions, brain morphology, and network architectures using computational models","volume":"50","author":"Wu","year":"2022","journal-title":"Ann Biomed Eng"},{"key":"2026021913192894700_usag047-B63","doi-asserted-by":"publisher","first-page":"88","DOI":"10.3389\/fneur.2013.00088","article-title":"Brain response to primary blast wave using validated finite element models of human head and advanced combat helmet","volume":"4","author":"Zhang","year":"2013","journal-title":"Front Neurol"},{"key":"2026021913192894700_usag047-B64","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17072392","article-title":"Influence of skull fracture on traumatic brain injury risk induced by blunt impact","volume":"17","author":"Ren","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2026021913192894700_usag047-B65","doi-asserted-by":"publisher","first-page":"2425","DOI":"10.1007\/s12206-018-0455-7","article-title":"Survivability assessment of a soldier wearing a ballistic helmet collided by a non-penetrating high speed projectile","volume":"32","author":"Kang","year":"2018","journal-title":"J Mech Sci Technol"},{"key":"2026021913192894700_usag047-B66","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.matdes.2016.12.081","article-title":"Effect of full helmet systems on human head responses under blast loading","volume":"117","author":"Rodr\u00edguez-Mill\u00e1n","year":"2017","journal-title":"Mater Design"},{"key":"2026021913192894700_usag047-B67","doi-asserted-by":"publisher","first-page":"111674","DOI":"10.1016\/j.jbiomech.2023.111674","article-title":"Mechanical mechanism and indicator of diffuse axonal injury under blast-type acceleration","volume":"156","author":"Du","year":"2023","journal-title":"J Biomech"},{"key":"2026021913192894700_usag047-B68","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1089\/neu.2019.6791","article-title":"Multi-Scale white matter tract embedded brain finite element model predicts the location of traumatic diffuse axonal injury","volume":"38","author":"Hajiaghamemar","year":"2021","journal-title":"J Neurotrauma"},{"key":"2026021913192894700_usag047-B69","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1007\/s10237-014-0643-z","article-title":"White matter tract-oriented deformation predicts traumatic axonal brain injury and reveals rotational direction-specific vulnerabilities","volume":"14","author":"Sullivan","year":"2015","journal-title":"Biomech Model Mechanobiol"},{"key":"2026021913192894700_usag047-B70","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1162\/netn_a_00277","article-title":"Exploring personalized structural connectomics for moderate to severe traumatic brain injury","volume":"7","author":"Imms","year":"2023","journal-title":"Netw Neurosci"},{"key":"2026021913192894700_usag047-B71","doi-asserted-by":"publisher","first-page":"e0221036","DOI":"10.1371\/journal.pone.0221036","article-title":"Brain-related proteins as serum biomarkers of acute, subconcussive blast overpressure exposure: a cohort study of military personnel","volume":"14","author":"Boutt\u00e9","year":"2019","journal-title":"PLoS One"},{"key":"2026021913192894700_usag047-B72","doi-asserted-by":"publisher","DOI":"10.1093\/cercor\/bhad405","article-title":"Serum biomarkers and disease progression in CT-negative mild traumatic brain injury","volume":"34","author":"Jia","year":"2024","journal-title":"Cereb Cortex"},{"key":"2026021913192894700_usag047-B73","doi-asserted-by":"publisher","first-page":"11772719221105145","DOI":"10.1177\/11772719221105145","article-title":"Progress toward a multiomic understanding of traumatic brain injury: a review","volume":"17","author":"Kocheril","year":"2022","journal-title":"Biomark Insights"},{"key":"2026021913192894700_usag047-B74","author":"Kocik","year":"2023"},{"key":"2026021913192894700_usag047-B75","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1089\/neu.2022.0338","article-title":"Head kinematics, blood biomarkers, and histology in large animal models of traumatic brain injury and hemorrhagic shock","volume":"40","author":"Mayer","year":"2023","journal-title":"J Neurotrauma"},{"key":"2026021913192894700_usag047-B76","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1038\/s41398-022-01853-w","article-title":"Plasma biomarkers associated with deployment trauma and its consequences in post-9\/11 era veterans: initial findings from the TRACTS longitudinal cohort","volume":"12","author":"Pierce","year":"2022","journal-title":"Transl Psychiatry"},{"key":"2026021913192894700_usag047-B77","doi-asserted-by":"publisher","first-page":"1179069519832286","DOI":"10.1177\/1179069519832286","article-title":"A review of MicroRNA biomarkers in traumatic brain injury","volume":"13","author":"Atif","year":"2019","journal-title":"J Exp Neurosci"},{"key":"2026021913192894700_usag047-B78","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1089\/neu.2011.2146","article-title":"MicroRNA let-7i is a promising serum biomarker for blast-induced traumatic brain injury","volume":"29","author":"Balakathiresan","year":"2012","journal-title":"J Neurotrauma"},{"key":"2026021913192894700_usag047-B79","doi-asserted-by":"publisher","DOI":"10.3390\/bios11090319","article-title":"The current state of traumatic brain injury biomarker measurement methods","volume":"11","author":"Krausz","year":"2021","journal-title":"Biosensors (Basel)"},{"key":"2026021913192894700_usag047-B80","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1080\/02699050701311042","article-title":"Diffusion tensor imaging fiber tractography for evaluating diffuse axonal injury","volume":"21","author":"Sugiyama","year":"2007","journal-title":"Brain Inj"},{"key":"2026021913192894700_usag047-B81","doi-asserted-by":"publisher","first-page":"74","DOI":"10.4103\/1673-5374.314285","article-title":"Positron emission tomography imaging for the assessment of mild traumatic brain injury and chronic traumatic encephalopathy: recent advances in radiotracers","volume":"17","author":"Huang","year":"2022","journal-title":"Neural Regen Res"},{"key":"2026021913192894700_usag047-B82","doi-asserted-by":"publisher","first-page":"5940","DOI":"10.1038\/s41380-020-0674-z","article-title":"Brain and blood biomarkers of tauopathy and neuronal injury in humans and rats with neurobehavioral syndromes following blast exposure","volume":"26","author":"Dickstein","year":"2021","journal-title":"Mol Psychiatry"},{"key":"2026021913192894700_usag047-B83","doi-asserted-by":"publisher","first-page":"24009","DOI":"10.1038\/s41598-021-03416-3","article-title":"From positron emission tomography to cell analysis of the 18-kDa translocator protein in mild traumatic brain injury","volume":"11","author":"Delage","year":"2021","journal-title":"Sci Rep"},{"key":"2026021913192894700_usag047-B84","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s40779-021-00363-y","article-title":"Military traumatic brain injury: a challenge straddling neurology and psychiatry","volume":"9","author":"Kong","year":"2022","journal-title":"Mil Med Res"},{"key":"2026021913192894700_usag047-B85","doi-asserted-by":"publisher","first-page":"365","DOI":"10.7205\/MILMED-D-12-00438","article-title":"Defense automated neurobehavioral assessment (DANA)-psychometric properties of a new field-deployable neurocognitive assessment tool","volume":"178","author":"Lathan","year":"2013","journal-title":"Mil Med"},{"key":"2026021913192894700_usag047-B86","doi-asserted-by":"publisher","first-page":"e26360","DOI":"10.2196\/26360","article-title":"Neurocognitive assessment tools for military personnel with mild traumatic brain injury: scoping literature review","volume":"8","author":"Jones","year":"2021","journal-title":"JMIR Ment Health"},{"key":"2026021913192894700_usag047-B87","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12165415","article-title":"Adverse outcome following mild traumatic brain injury is associated with microstructure alterations at the gray and white matter boundary","volume":"12","author":"Pankatz","year":"2023","journal-title":"J Clin Med"},{"key":"2026021913192894700_usag047-B88","doi-asserted-by":"publisher","first-page":"e027845","DOI":"10.1136\/bmjopen-2018-027845","article-title":"Evaluating the impact of cycle helmet use on severe traumatic brain injury and death in a national cohort of over 11000 pedal cyclists: a retrospective study from the NHS England trauma audit and research network dataset (vol 9, e027845, 2019)","volume":"9","author":"Dodds","year":"2019","journal-title":"BMJ Open"},{"key":"2026021913192894700_usag047-B89","article-title":"Ballistic head protection in the light of injury criteria in the case of the wz.93 combat helmet","volume":"9","author":"Jamroziak","year":"2019","journal-title":"Appl Sci-Basel"},{"key":"2026021913192894700_usag047-B90","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0228802","article-title":"Primary blast wave protection in combat helmet design: a historical comparison between present day and world war I","volume":"15","author":"Op \u2018t Eyndee","year":"2020","journal-title":"PLoS One"},{"key":"2026021913192894700_usag047-B91","doi-asserted-by":"publisher","first-page":"186","DOI":"10.3389\/fneur.2013.00186","article-title":"Assessing neuro-systemic & behavioral components in the pathophysiology of blast-related brain injury","volume":"4","author":"Kobeissy","year":"2013","journal-title":"Front Neurol"},{"key":"2026021913192894700_usag047-B92","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1136\/jramc-2013-000108","article-title":"Defining combat helmet coverage for protection against explosively propelled fragments","volume":"161","author":"Breeze","year":"2015","journal-title":"J R Army Med Corps"},{"key":"2026021913192894700_usag047-B93","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1136\/bmjmilitary-2021-001833","article-title":"Comparing the medical coverage provided by four contemporary military combat helmets against penetrating traumatic brain injury","volume":"168","author":"Breeze","year":"2022","journal-title":"BMJ Mil Health"},{"key":"2026021913192894700_usag047-B94","first-page":"17","article-title":"A study of the response of the human cadaver head to impact","volume":"51","author":"Hardy","year":"2007","journal-title":"Stapp Car Crash J"},{"key":"2026021913192894700_usag047-B95","author":"King","year":"2003"},{"key":"2026021913192894700_usag047-B96","doi-asserted-by":"publisher","first-page":"768","DOI":"10.3171\/2016.2.JNS151972","article-title":"Helmet efficacy against concussion and traumatic brain injury: a review","volume":"126","author":"Sone","year":"2017","journal-title":"J Neurosurg"},{"key":"2026021913192894700_usag047-B97","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1038\/nrn3407","article-title":"Animal models of traumatic brain injury","volume":"14","author":"Xiong","year":"2013","journal-title":"Nat Rev Neurosci"},{"key":"2026021913192894700_usag047-B98","doi-asserted-by":"publisher","first-page":"413","DOI":"10.4103\/1673-5374.245334","article-title":"The pig as a preclinical traumatic brain injury model: current models, functional outcome measures, and translational detection strategies","volume":"14","author":"Kinder","year":"2019","journal-title":"Neural Regen Res"},{"key":"2026021913192894700_usag047-B99","doi-asserted-by":"publisher","first-page":"70","DOI":"10.3389\/fneur.2012.00070","article-title":"Porcine head response to blast","volume":"3","author":"Shridharani","year":"2012","journal-title":"Front Neurol"},{"key":"2026021913192894700_usag047-B100","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1093\/milmed\/usx210","article-title":"Preliminary investigation of skull fracture patterns using an impactor representative of helmet back-face deformation","volume":"183","author":"Weisenbach","year":"2018","journal-title":"Mil Med"},{"key":"2026021913192894700_usag047-B101","doi-asserted-by":"crossref","DOI":"10.1016\/j.compositesb.2022.109890","article-title":"Ballistic helmets: recent advances in materials, protection mechanisms, performance, and head injury mitigation","volume":"238","author":"Li","year":"2022","journal-title":"Compos Part B-Eng"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag047\/66992816\/usag047.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag047\/66992816\/usag047.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T18:19:35Z","timestamp":1771525175000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag047\/8490673"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":101,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag047","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]},"article-number":"usag047"}}