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Blast Lung Injury Severity Score

Blast Lung Injury Severity Score is used to gauge the severity of a blast lung injury. A blast lung injury results in pulmonary dysfunction. Information from a chest x-ray, the partial arterial oxygen pressure- fractional inspired oxygen ratio, and presence of a bronchial pleural fistula are incorporated into the Blast Lung Injury Severity Score.
>200 0
60 to 200 1
<60 2
Chest x-ray
Localized lung infiltrates 0
Bilateral or unilateral lung infiltrates 1
Massive bilateral lung infiltrates 2
Bronchial pleural fistula
No 0
Yes 1


Measured Factor
Blast Lung Injury Severity Score
Measured Factor Disease
  • Severity of blast lung injury
Measured Factor Detail
The Blast Lung Injury Severity Score is used to categorize a patient's blast lung injury. The patient's score is used to assist in determining appropriate ventilator therapy. A blast injury may occur after an explosion. A blast injury presents without a clear sign of injury but with a patient in respiratory distress. Injury is suspected to be caused from capillary rupture in the aveoli, resulting in decreased gas exchange.
Body System
Measured Factor Low Impact
  • Mild blast injury patients require a positive end-expiratory pressure less than or equal to 5 centimeters of water. Moderate blast injury patients require a poisitve end-expiratory pressure between 5 to 10 centimeteres of water.
Measured Factor High Impact
  • High blast injury patients require a positive end-expiratory pressure greater than 10 centimeters of water.
  • N/A

Result Interpretation

Ranges Ranges
  • Critical Low: 0-4 points
  • Critical High: 5 points
  • Normal: 0 points
  • Normal Adult Male: N/A
  • Normal Adult Female: N/A
  • Normal Pediatric: N/A
  • Normal Neonate Female: N/A
  • Normal Geriatric Male: N/A
  • Normal Geriatric Female: N/A
Result Low Conditions
  • N/A
Result High Conditions
  • Blast injury to the lung
False Positive
  • Lung infiltrates on a x-ray
  • bronchial pleural fistula
  • low ratio of arterial oxygen partial pressure to fractional inspired oxygen
References: 2
Test Limitations
References: 2


Study Validation 1
The immediate results of blast injury have been studied. The long-term results of blast injury have not been studied. This study aimed to look at lung function in patients 1 year after blast injury. Eleven patients were enrolled in the study at Hadassah Medical Center in Jerusalem. These patients were recruited after surviving a terrorist explosion. This was a prospective study. A year after the injury none of the patients had any pulmonary issues. All of the eleven patients had normal lung function and normal pulmonary exams.
References: 3
Study Validation 2
Blast injury is becoming an increasing common occurrence. Blast injury is a common consequence of a terrorist bomb attack. This study aim to characterize blast injuries and their outcomes. 916 patients were examined following terrorist bomb attacks between December 1983 and February 2004 in Jerusalem. 41 patients were admitted into the intensive care unit. 29 patients met inclusion criteria and were included in the study. This was a retrospective study. Pulmonary infiltrates were seen in all 29 patients. 22 patients required mechanical ventilation. The median for mechanical ventilation was 4 days. 86% of patients experienced ruptured tympanic membranes. 52% of patients experienced burns. 28% of patients experienced fractures. 76% of patients had no long-term complications from the blast injury.
References: 4
Study Validation 3
This study aimed to compare blast injuries resulting from explosions in the open air versus confined space. Four bombing events were included in this study that effected 297 patients total. 2 bombings occurred in the open air and 2 occurred in a confined space. 15 of 204 patients died from the open air bombing. 46 of 93 patients died from the confined space bombing. More primary blast lung injuries were seen in the confined space bombing. Injuries from explosions in confined spaces are more severe and result in increased mortality.
References: 5
Study Additional 1
Blast injury is becoming an increasing common occurrence. Blast injury is a common consequence of a terrorist bomb attack. This study aimed to study the effects of blast injuries on the ear. Between May 2002 and October 2014, 41 patients were included in the study. All patients admitted to a hospital in Paris, France, were included. 36 patients reported tinnitus, 25 hearing loss, 14 earache, and 8 vertigo. Blast injuries result in significant ear injury.
References: 6
Study Additional 2
It has been studied that blast injury often results in ear injury. This study aimed to determine is isolated tympanic membrane perforation is a marker for blast lung injury.  Between April 1994 and March 1996, 647 terrorist bombing survivors were evaluated. 183 patients had primary blast injury. 142 of these patients with primary blast injury had eardrum perforation. No patients in the study who presented with isolated tympanic membrane perforation later had lung injury.
References: 7
Study Additional 3
Dismounted complex blast injury (DCBI) is commonly seen in military combat in the Middle East. This paper aimed to discuss diagnosis of DCBI, initial management, and potential complications. DCBI are those injuries caused outside of a vehicle. Hemorrhage and multiorgan failure can result and potentially cause death.  Tourniquets and a pelvic binder are typically used immediately in an attempt to prevent hemorrhage. CT scan should be used to evaluate other injuries, so appropriate interventions can be made.
References: 8


Reuven Pizov
MD, Hadassah Medical Center


  1. Pizov R, Oppenheim-Eden A, Matot I, Weiss YG, Eidelman LA, Rivkind AI, Sprung CL.Blast lung injury from an explosion on a civilian bus.Chest. 1999 Jan;115(1):165-72.
  2. N/A
  3. Hirshberg B, Oppenheim-Eden A, Pizov R, Sklair-Levi M, Rivkin A, Bardach E, Bublil M, Sprung C, Kramer MR.Recovery from blast lung injury: one-year follow-up.Chest. 1999 Dec;116(6):1683-8.
  4. Avidan V, Hersch M, Armon Y, Spira R, Aharoni D, Reissman P, Schecter WP.Blast lung injury: clinical manifestations, treatment, and outcome. Am J Surg. 2005 Dec;190(6):927-31.
  5. Leibovici D, Gofrit ON, Stein M, Shapira SC, Noga Y, Heruti RJ, Shemer J.Blast injuries: bus versus open-air bombings--a comparative study of injuries in survivors of open-air versus confined-space explosions.J Trauma. 1996 Dec;41(6):1030-5.
  6. Ballivet de Régloix S, Crambert A, Maurin O, Lisan Q, Marty S, Pons Y.Blast injury of the ear by massive explosion: a review of 41 cases.J R Army Med Corps. 2017 Oct;163(5):333-338.
  7. Leibovici D, Gofrit ON, Shapira SC.Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury?Ann Emerg Med. 1999 Aug;34(2):168-72.
  8. Cannon JW, Hofmann LJ, Glasgow SC, Potter BK, Rodriguez CJ, Cancio LC, Rasmussen TE, Fries CA, Davis MR, Jezior JR, Mullins RJ1, Elster EA. Dismounted Complex Blast Injuries: A Comprehensive Review of the Modern Combat Experience.J Am Coll Surg. 2016 Oct;223(4):652-664.e8.

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