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Objectives and questions: Severe blast injuries are rare in both civilian and military environments. High casualty rates and limited experience in dealing with blast injuries (BI) pose logistical and operational challenges to military and civilian care facilities. The aim of this systematic review was to investigate injury patterns following an explosion

Material and methods: A database search was conducted on Scopus and PubMed. All observational studies with civilians and military personnel of all age groups who reported detailed BI pattern were included. Individuals injured in explosion without relation to war or terror like household explosions were excluded. Due to insufficient data quality related to missing data and inadequate reporting, a narrative data synthesis was performed.

Results: The search on January 5, 2023, resulted in 1,354 hits. After screening and hand searching, 117 studies (improvised explosive devices (IED) n=27, multiple explosive devices n=35, terrorist attacks & suicide bombings n=41 and landmines n=12) from 24 countries met the inclusion criteria. The studies were mostly register-, hospital data-based or case reports/series. The injured persons within the studies were > 60% men aged 20–35 years; however demographic information was often missing.

Many studies report general injury pattern of the included populations; hence they attempt to illustrate the magnitude of injuries patients sustains due to a specific incident (e.g. patients who required hospital care after the bombing in Madrid, Spain 2004). Extremity, head and facial injuries were most frequently reported. Abdominal and spinal injuries were the least frequently reported injuries. The most heterogeneous and/or incomplete reporting concerned external injuries, burns, pelvic & vertebral fractures.

Other studies focused on specific anatomical regions and highlighted the range of injuries that patients suffered in this region e.g. open pelvic fracture due to mounted IED explosions, spinal fractures due to dismounted IED explosions or eye injuries due to landmine clearing operations.

Discussion and conclusions: Extremity injuries are the most common injuries in the majority of included studies. The reporting of included studies was very heterogeneous and inadequate. There is an urgent need for uniform reporting of BI pattern in order to allow a better understanding of injury pattern, required specialist disciplines. This is essential to improve emergency care and treatment concepts.