{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T01:33:32Z","timestamp":1787621612112,"version":"build-2736575974"},"reference-count":13,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J R Army Med Corps"],"accepted":{"date-parts":[[2013,6,26]]},"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The world remains plagued by wars and terrorist attacks, and improvised explosive devices (IED) are the main weapons of our current enemies, causing almost two-thirds of all combat injuries. We wished to analyse the pattern of blast trauma on the modern battlefield and to compare it with combat gunshot injuries.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and methods<\/jats:title>\n                  <jats:p>Analysis of a consecutive series of combat trauma patients presenting to two Bulgarian combat surgical teams in Afghanistan over 11\u2005months. Demographics, injury patterns and Injury Severity Scores (ISS) were compared between blast and gunshot-injured casualties using Fisher's Exact Test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The blast victims had significantly higher median ISS (20.54 vs 9.23) and higher proportion of ISS&gt;16 (60% vs 33.92%, p=0.008) than gunshot cases. They also had more frequent involvement of three or more body regions (47.22% vs 3.58%, p&lt;0.0001). A significantly higher frequency of head (27.27% vs 3.57%), facial (20% vs 0%) and extremities injuries (85.45% vs 42.86%) and burns (12.72% vs 0%) was noted among the victims of explosion (p&lt;0.0001). Based on clinical examination and diagnostic imaging, primary blast injury was identified in 24\/55 (43.6%), secondary blast injury in 37 blast cases (67.3%), tertiary in 15 (27.3%) and quaternary blast injury (all burns) in seven (12.72%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our results corroborate the \u2018multidimensional\u2019 injury pattern of blast trauma. The complexity of the blast trauma demands a good knowledge and a special training of the military surgeons and hospital personnel before deployment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jramc-2013-000132","type":"journal-article","created":{"date-parts":[[2013,7,18]],"date-time":"2013-07-18T20:39:23Z","timestamp":1374179963000},"page":"52-55","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["A modern combat trauma"],"prefix":"10.1136","volume":"160","author":[{"given":"Georgi","family":"Popivanov","sequence":"first","affiliation":[{"name":"Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V M","family":"Mutafchiyski","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary, Pancreatic and Transplantation Surgery, Military Medical Academy, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E I","family":"Belokonski","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A B","family":"Parashkevov","sequence":"additional","affiliation":[{"name":"Department of Military Medical Detachment for Emergency Response, Military Medical Academy, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G L","family":"Koutin","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2013,7,18]]},"reference":[{"key":"2025081313433915000_160.1.52.1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/s00423-011-0760-4","article-title":"\"Einsatzchirurgie\"\u2014experience of German military surgeons in Afghanistan","volume":"396","author":"Willy","year":"2011","journal-title":"Langebecks Arch Surg"},{"key":"2025081313433915000_160.1.52.2","first-page":"235","article-title":"Bomb explosions in acts of terrorism\u2014detonation, wound ballistics, triage and medical concerns","volume":"5","author":"Kluger","year":"2003","journal-title":"IMAJ"},{"key":"2025081313433915000_160.1.52.3","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.2106\/00004623-200207000-00022","article-title":"Blast and fragment injuries of the musculoskeletal system","volume":"84","author":"Dana","year":"2002","journal-title":"J Bone Joint Surg"},{"key":"2025081313433915000_160.1.52.4","doi-asserted-by":"crossref","unstructured":"Baskin TW Holcomb JB . Bombs, mines, blast, fragmentation, and thermobaric mechanisms of injury. In: Mahoney PF Ryan J Brooks AJ Schwab CW , eds. Ballistic trauma: a practical guide. 2nd edn. London: Springer, 2005; Chapter 3:45\u201366.","DOI":"10.1007\/1-84628-060-5_3"},{"key":"2025081313433915000_160.1.52.5","unstructured":"Diebel LN . Stomach and small bowel. In: Feliciano DV Mattox KL Moore EE , eds. Trauma. 6th edn. McGraw-Hill, 2008; Chapter 34:681\u2013700."},{"key":"2025081313433915000_160.1.52.6","doi-asserted-by":"publisher","DOI":"10.1186\/1749-7922-1-33"},{"key":"2025081313433915000_160.1.52.7","doi-asserted-by":"crossref","unstructured":"Brooks AJ Civil I Braslow B . Abdomen and pelvis. In: Mahoney PF Ryan J Brooks AJ Schwab CW , eds. Ballistic trauma: a practical guide. 2nd edn. London: Springer, 2005; Chapter 14:299\u2013324.","DOI":"10.1007\/1-84628-060-5_14"},{"key":"2025081313433915000_160.1.52.8","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/SLA.0b013e318180a3f7","article-title":"Abdominal trauma after terrorist bombing attacks exhibit a unique pattern of injury","volume":"248","author":"Bala","year":"2008","journal-title":"Ann Surg"},{"key":"2025081313433915000_160.1.52.9","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000219645.88867.b7"},{"key":"2025081313433915000_160.1.52.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2004.09.003"},{"key":"2025081313433915000_160.1.52.11","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000114012.84732.be"},{"key":"2025081313433915000_160.1.52.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2006.05.010"},{"key":"2025081313433915000_160.1.52.13","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jamcollsurg.2009.01.049","article-title":"Bomb explosions in act of terrorism: evil creativity challenges our trauma systems","volume":"1","author":"Kashuk","year":"2009","journal-title":"J Am Coll Surg"}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-2013-000132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T20:43:50Z","timestamp":1755117830000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-2013-000132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,7,18]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2014,2,17]]},"published-print":{"date-parts":[[2014,3]]}},"alternative-id":["10.1136\/jramc-2013-000132"],"URL":"https:\/\/doi.org\/10.1136\/jramc-2013-000132","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"value":"0035-8665","type":"print"},{"value":"2052-0468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,7,18]]}}}