Perspectives on Development of Measures to Estimate Career Blast Exposure History in Service Members and Veterans

Abstract

The Department of Defense (DOD) has recently prioritized the investigation of the acute and chronic adverse brain health and performance effects of low-level blast (LLB) generated by the use of weapons systems. While acute exposure can be quantified by sensor technology, career exposure has no widely accepted and validated measure for characterization. Currently, distinct research groups are developing and validating four promising measures to estimate career blast exposure history: the Salisbury Blast Interview, Blast Exposure Threshold Survey, Blast Ordnance and Occupational Exposure Measure, and the Blast Frequency and Symptom Severity. Each measure offers an assessment of blast history that is uniquely beneficial to addressing specific research questions. However, use of divergent strategies is not efficient to accelerate the field's understanding of the impact of career exposure and Service-connected health outcomes. As a DOD-wide solution, collaboration across these groups is required to develop a tool(s) that can be standardized across research studies and, ultimately, pared down to be implemented in clinical settings. Here, we overview the current four measures and provide a perspective on the way forward for optimization and/or combination in support of this solution.

Impact of repeated blast exposure on active-duty United States Special Operations Forces

“…The GBEV has not been validated against blast gauge data as a tool for estimating blast exposure. Its precision, accuracy, and potential susceptibility to recall bias are areas of ongoing investigation ( 27 ). The GBEV also reports the recency of blast exposure in units of years, not days or weeks.…”

Considerations for the assessment of blast exposure in service members and veterans

“…These include dedicated TBI evaluations, dedicated blast evaluations, ad hoc items to evaluate blast exposure, and body mounted sensors using various calculated outcomes. Many of these measures have been reviewed elsewhere; however, there are several key points that warrant restatement ( 46 ). First, TBI interviews typically include an evaluation of the injury mechanism, with blast being just one of many.…”

“…Dedicated evaluations of blast offer a more comprehensive characterization of blast exposure than TBI interviews, specifically because they capture events that are not considered potentially concussive ( 46 ). Most available measures evaluate the frequency of different types of blast exposures.…”

“…However, there has been no validation of these added blast event items. Therefore, it is critical that blast exposure be characterized using dedicated assessment measures that have been well-validated ( 46 ). The development and validation of blast measures is an area that will benefit from continued refinement to identify the characteristics of blast events most relevant to negative outcomes and the most robust method of measuring these characteristics.…”

Lifetime Blast Exposure Is Not Related to White Matter Integrity in Service Members and Veterans With and Without Uncomplicated Mild Traumatic Brain Injury

“…Importantly, blast exposure is difficult to estimate, particularly across one's lifetime. Whereas pressure sensors have been used to assess blast exposure over relatively short intervals during training, 21 , 22 lifetime blast exposure has generally been conducted by assessment methods varying from a single question 6 , 23–26 to structured interviews assessing myriad types of weapon systems (for a review, see Turner and colleagues) 27 and interviews that account for distance from the blast. 28 , 29 No measure is able to accurately capture the force of individual blasts over a lifetime, each of which is dependent on environmental factors including distance from the original blast, whether the blast occurred in an enclosed space, personal protective equipment, and whether there were objects between a person and the source of the blast.…”