Clinical Priorities

Work carried out in CBIS has shown that both mounted and dismounted troops commonly suffer from musculoskeletal (MSK) injuries that spread over more than one body region. It has also shown that injury patterns in spine, pelvis, and lower limb are substantially different in dismounted and mounted troops. Whilst the mechanisms of injury are not yet fully understood, it is likely that the force of the shock wave combined with the blast wind that follows and contains energised particles causes flail of the limbs, displacing the individual, and causing penetrative injuries.

Our research looks to better understand the pathophysiology of the MSK and extremity blast injury in order to reduce the injury burden. We will develop mitigation strategies, investigate treatments (e.g. surgical interventions and regenerative engineering) and work to improve rehabilitation pathways for those with MSK and extremity injuries. Much of our work in this area is with those who have sustained amputations following blast injury. 

Researchers: Professor Anthony Bull, Professor (Colonel) Jon Clasper, Dr Claire Higgins, Dr Angela Kedgley, Dr Spyros Masouros, Professor Alison McGregor, Dr Andrew Phillips, Dr Bill Proud, Professor Andrew Rice. 

Heterotopic ossification (HO) is the presence of bone in soft tissue where bone normally does not exist. This occurs in 60-65% of amputees from recent conflicts in Iraq and Afghanistan. As its occurrence has a direct impact on rehabilitation, it poses a significant clinical problem to the military.

Researchers are characterising the biology and structure of blast-induced HO as well as creating experimental models of the formation of HO at the cellular and whole systems levels. These experiments will help to design targeted interventions to treat HO.

Researchers: Professor Anthony Bull, Dr Claire Higgins.

An escalating problem in the military is hearing damage caused by blast. Hearing damage accounted for 23% of all injuries during Operation Iraqi Freedom.

Auditory Processing Disorder (APD) is a hearing problem where the brain is unable to process sounds in the normal way, due to a compromise to the neural circuits, which are responsible for analysing auditory signals. Researchers work with cohorts of people who have experienced APD to improve rehabilitation. CBIS researchers are also conducting analyses to identify the incidence and scale of hearing loss due to blast to inform mitigation strategies and using a number of models that can be used to look at potential treatments.

Researchers: Dr Andrei Kozlov.

Data from both the UK and US, has shown Traumatic Brain Injury (TBI) to be a major problem for military personnel. Although an increase in overall survival rates has been seen in more recent conflicts, it has not been matched by an improvement in outcome following severe head injuries which, together with haemorrhage remain the most common causes of death on the battlefield. As a result, there is a need to understand the reason for this poor outcome, which will allow targeted research in the relevant area.

In order to provide insights into blast TBI injury, the work carried out in CBIS utilises computational modelling, neuroimaging, behaviour, and histopathology. Understanding more about the injury will allow us to look into improving monitoring, protection and/or mitigation, by helmet or vehicle design. We will also consider specific early treatments and optimising rehabilitation of the head injured patient.

Researchers: Dr Robert Dickinson, Dr Mazdak Ghajari, Professor David Sharp, Professor Mark Wilson. 

Four key aspects make up this clinical priority area:

1)    In order to enable the analysis of the continuum of injuries, we will need to identify the causes of death as well as major wounding in survivors.

2)    We look at the next level of survivors to target research in mitigation, protection and therapy to increase the potential survival in those with previously unsurvivable injuries. This cuts across all Clinical Priority areas.

3)    Using clinical scoring systems we will develop and access datasets to enable more appropriate scoring systems to be developed that facilitate clinical decision making (e.g. treatment).

4)    As UK military wounding in conflict has reduced in recent years, CBIS will work on developing the analysis of blast injuries through analysing civilian blast injury correlates (e.g. through terrorist actions) and through exploring the relationship of high energy civilian trauma to blast injuries.

Researchers: Professor Anthony Bull, Professor (Colonel) Jon Clasper, Professor Mark Wilson.

Due to the very delicate nature of internal organs and major blood vessels in the torso, they are particularly susceptible to trauma. These organs may be injured as a result of penetrating fragments or close proximity overpressure. Recent work within the Centre has demonstrated that visceral injuries, particularly those to the heart and great vessels, are the strongest indicator of death within the mounted casualty cohort.

Lung injury has long been a focus of blast injury research. The exact mechanisms of blast trauma to the lung due to blast, from the instantly fatal to the longer term, remain unknown.

For many casualties, torso injury, including tertiary blast lung injury, is not survivable. Therefore we focus our work on mitigation strategies and understanding the injury mechanism.

Researchers: Professor Anthony Bull, Professor (Colonel) Jon Clasper.