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Characterisation of retained energised fragments from explosive devices in military personnel

IntroductionCharacterising the shapes, dimensions and overall numbers of fragments produced by explosive devices is important for determining methods of potential mitigation, such as personal armour. The aim of this investigation was to compare the mass of excised fragments with that predicted from...

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Published in:BMJ military health 2022-10, Vol.168 (5), p.391-394
Main Authors: Breeze, John, Steel, C J, Streit, A, Sarber, K M
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Streit, A
Sarber, K M
description IntroductionCharacterising the shapes, dimensions and overall numbers of fragments produced by explosive devices is important for determining methods of potential mitigation, such as personal armour. The aim of this investigation was to compare the mass of excised fragments with that predicted from CT to ascertain the validity of using such an approach to measure retained fragments for multiple body areas using CT alone.Method27 retained fragments excised from consecutive patients treated at a US Role 3 Medical Treatment Facility in Afghanistan were examined. Each fragment was measured in three dimensions and the mass was obtained to estimate the density and thereby probable composition. These same excised fragments were identified radiologically and their predicted masses calculated and compared with the known masses with a paired t-test. The total numbers of retained fragments in each of four body areas for 20 casualties were determined radiographically and the mass of the largest fragment in each body region estimated.ResultsExcised fragments were most commonly metallic (17/27, 63%), with masses ranging from 0.008 to 37.6 g. Mean mass predicted from CT was significantly different from than that measured (p=0.133), with CT underestimating true mass by 5%–17%. 889/958 (93%) retained fragments appeared metallic on imaging, with the most commonly affected body areas being the torso and upper extremity (45% of casualties).ConclusionsPredicting the mass of metallic fragments from CT was possible with an error margin of up to 5%, but was less accurate for non-metallic fragments such as stone. Only 3% of fragments were removed through debridement or purposeful excision; these were not just the largest or most superficial. This suggests that future retrospective analysis of the dimensions and predicted masses of retained fragments in larger casualty cohorts of service personnel is potentially feasible within a small margin of error.
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The aim of this investigation was to compare the mass of excised fragments with that predicted from CT to ascertain the validity of using such an approach to measure retained fragments for multiple body areas using CT alone.Method27 retained fragments excised from consecutive patients treated at a US Role 3 Medical Treatment Facility in Afghanistan were examined. Each fragment was measured in three dimensions and the mass was obtained to estimate the density and thereby probable composition. These same excised fragments were identified radiologically and their predicted masses calculated and compared with the known masses with a paired t-test. The total numbers of retained fragments in each of four body areas for 20 casualties were determined radiographically and the mass of the largest fragment in each body region estimated.ResultsExcised fragments were most commonly metallic (17/27, 63%), with masses ranging from 0.008 to 37.6 g. Mean mass predicted from CT was significantly different from than that measured (p=0.133), with CT underestimating true mass by 5%–17%. 889/958 (93%) retained fragments appeared metallic on imaging, with the most commonly affected body areas being the torso and upper extremity (45% of casualties).ConclusionsPredicting the mass of metallic fragments from CT was possible with an error margin of up to 5%, but was less accurate for non-metallic fragments such as stone. Only 3% of fragments were removed through debridement or purposeful excision; these were not just the largest or most superficial. This suggests that future retrospective analysis of the dimensions and predicted masses of retained fragments in larger casualty cohorts of service personnel is potentially feasible within a small margin of error.</description><identifier>ISSN: 2633-3767</identifier><identifier>EISSN: 2633-3775</identifier><identifier>DOI: 10.1136/bmjmilitary-2021-001825</identifier><identifier>PMID: 34131063</identifier><language>eng</language><publisher>London: British Medical Journal Publishing Group</publisher><subject>Casualties ; computed tomography ; Debridement ; diagnostic radiology ; Medical imaging ; Medical treatment ; Military personnel ; Military supplies ; Original research ; orthopaedic &amp; trauma surgery ; Surgery ; Trauma ; Validity</subject><ispartof>BMJ military health, 2022-10, Vol.168 (5), p.391-394</ispartof><rights>Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2022 Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-b351t-66429402625724e5438a7aafc645434d5e9ab4c867526e40db6ccd2c7f0a4bf73</cites><orcidid>0000-0002-2352-1365</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://militaryhealth.bmj.com/content/early/2021/06/14/bmjmilitary-2021-001825.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://militaryhealth.bmj.com/content/early/2021/06/14/bmjmilitary-2021-001825.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>112,113,314,780,784,3194,27924,27925,55341,77466,77467,77468,77469</link.rule.ids></links><search><creatorcontrib>Breeze, John</creatorcontrib><creatorcontrib>Steel, C J</creatorcontrib><creatorcontrib>Streit, A</creatorcontrib><creatorcontrib>Sarber, K M</creatorcontrib><title>Characterisation of retained energised fragments from explosive devices in military personnel</title><title>BMJ military health</title><addtitle>BMJ Mil Health</addtitle><description>IntroductionCharacterising the shapes, dimensions and overall numbers of fragments produced by explosive devices is important for determining methods of potential mitigation, such as personal armour. The aim of this investigation was to compare the mass of excised fragments with that predicted from CT to ascertain the validity of using such an approach to measure retained fragments for multiple body areas using CT alone.Method27 retained fragments excised from consecutive patients treated at a US Role 3 Medical Treatment Facility in Afghanistan were examined. Each fragment was measured in three dimensions and the mass was obtained to estimate the density and thereby probable composition. These same excised fragments were identified radiologically and their predicted masses calculated and compared with the known masses with a paired t-test. The total numbers of retained fragments in each of four body areas for 20 casualties were determined radiographically and the mass of the largest fragment in each body region estimated.ResultsExcised fragments were most commonly metallic (17/27, 63%), with masses ranging from 0.008 to 37.6 g. Mean mass predicted from CT was significantly different from than that measured (p=0.133), with CT underestimating true mass by 5%–17%. 889/958 (93%) retained fragments appeared metallic on imaging, with the most commonly affected body areas being the torso and upper extremity (45% of casualties).ConclusionsPredicting the mass of metallic fragments from CT was possible with an error margin of up to 5%, but was less accurate for non-metallic fragments such as stone. Only 3% of fragments were removed through debridement or purposeful excision; these were not just the largest or most superficial. This suggests that future retrospective analysis of the dimensions and predicted masses of retained fragments in larger casualty cohorts of service personnel is potentially feasible within a small margin of error.</description><subject>Casualties</subject><subject>computed tomography</subject><subject>Debridement</subject><subject>diagnostic radiology</subject><subject>Medical imaging</subject><subject>Medical treatment</subject><subject>Military personnel</subject><subject>Military supplies</subject><subject>Original research</subject><subject>orthopaedic &amp; trauma surgery</subject><subject>Surgery</subject><subject>Trauma</subject><subject>Validity</subject><issn>2633-3767</issn><issn>2633-3775</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNqVkUtPwzAQhC0EolXpbyASFy4Bv2InR1TxkipxgSOyHGdTXCV2sdMK_j2uCgVxQZx2DvOtZncQOiX4ghAmLut-2dvODjq85xRTkmNMSlocoDEVjOVMyuJwr4UcoWmMS4wxpaLEjB-jEeOEESzYGD3PXnTQZoBgox6sd5lvswCDtg6aDByEhY1JtUEvenBDTMr3GbytOh_tBrIGNtZAzKzLvkJlKwjROwfdCTpqdRdh-jkn6Onm-nF2l88fbu9nV_O8ZgUZciE4rTimghaScig4K7XUujWCJ82bAipdc1MKWVABHDe1MKahRrZY87qVbILOd3tXwb-uIQ6qt9FA12kHfh0VLTiRZSl5laxnv6xLvw4upVNUUlZWvEqPmyC5c5ngYwzQqlWwfbpNEay2JagfJahtCWpXQiLpjkyGf0DsG9rn-Yv6ANgxnes</recordid><startdate>20221001</startdate><enddate>20221001</enddate><creator>Breeze, John</creator><creator>Steel, C J</creator><creator>Streit, A</creator><creator>Sarber, K M</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2352-1365</orcidid></search><sort><creationdate>20221001</creationdate><title>Characterisation of retained energised fragments from explosive devices in military personnel</title><author>Breeze, John ; Steel, C J ; Streit, A ; Sarber, K M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b351t-66429402625724e5438a7aafc645434d5e9ab4c867526e40db6ccd2c7f0a4bf73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Casualties</topic><topic>computed tomography</topic><topic>Debridement</topic><topic>diagnostic radiology</topic><topic>Medical imaging</topic><topic>Medical treatment</topic><topic>Military personnel</topic><topic>Military supplies</topic><topic>Original research</topic><topic>orthopaedic &amp; trauma surgery</topic><topic>Surgery</topic><topic>Trauma</topic><topic>Validity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Breeze, John</creatorcontrib><creatorcontrib>Steel, C J</creatorcontrib><creatorcontrib>Streit, A</creatorcontrib><creatorcontrib>Sarber, K M</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>BMJ military health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Breeze, John</au><au>Steel, C J</au><au>Streit, A</au><au>Sarber, K M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characterisation of retained energised fragments from explosive devices in military personnel</atitle><jtitle>BMJ military health</jtitle><stitle>BMJ Mil Health</stitle><date>2022-10-01</date><risdate>2022</risdate><volume>168</volume><issue>5</issue><spage>391</spage><epage>394</epage><pages>391-394</pages><issn>2633-3767</issn><eissn>2633-3775</eissn><abstract>IntroductionCharacterising the shapes, dimensions and overall numbers of fragments produced by explosive devices is important for determining methods of potential mitigation, such as personal armour. The aim of this investigation was to compare the mass of excised fragments with that predicted from CT to ascertain the validity of using such an approach to measure retained fragments for multiple body areas using CT alone.Method27 retained fragments excised from consecutive patients treated at a US Role 3 Medical Treatment Facility in Afghanistan were examined. Each fragment was measured in three dimensions and the mass was obtained to estimate the density and thereby probable composition. These same excised fragments were identified radiologically and their predicted masses calculated and compared with the known masses with a paired t-test. The total numbers of retained fragments in each of four body areas for 20 casualties were determined radiographically and the mass of the largest fragment in each body region estimated.ResultsExcised fragments were most commonly metallic (17/27, 63%), with masses ranging from 0.008 to 37.6 g. Mean mass predicted from CT was significantly different from than that measured (p=0.133), with CT underestimating true mass by 5%–17%. 889/958 (93%) retained fragments appeared metallic on imaging, with the most commonly affected body areas being the torso and upper extremity (45% of casualties).ConclusionsPredicting the mass of metallic fragments from CT was possible with an error margin of up to 5%, but was less accurate for non-metallic fragments such as stone. Only 3% of fragments were removed through debridement or purposeful excision; these were not just the largest or most superficial. This suggests that future retrospective analysis of the dimensions and predicted masses of retained fragments in larger casualty cohorts of service personnel is potentially feasible within a small margin of error.</abstract><cop>London</cop><pub>British Medical Journal Publishing Group</pub><pmid>34131063</pmid><doi>10.1136/bmjmilitary-2021-001825</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0002-2352-1365</orcidid></addata></record>
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subjects Casualties
computed tomography
Debridement
diagnostic radiology
Medical imaging
Medical treatment
Military personnel
Military supplies
Original research
orthopaedic & trauma surgery
Surgery
Trauma
Validity
title Characterisation of retained energised fragments from explosive devices in military personnel
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