Prediction of primary blast lung injury outcomes in goats using CT and injury factors

To investigate the feasibility of using CT combined with injury factors to predict the lethality and severity of primary blast lung injury through establishing a goat model simulating real explosion effects.

High explosives were detonated at two altitudes in natural fields, with goats positioned at distances of 2 to 6 meters from the explosion center, facing either the right side or the front chest. CT features and quantitative data post-injury were recorded, along with blood gas analysis in surviving goats and lung coefficient measurements. Correlation analysis between CT severity score and lung coefficient was performed. ROC curve analysis was conducted to evaluate the multi-factors in distinguishing severity (severe/serious vs. moderate/slight) and lethality (death vs. survival). Nomograms based on injury factors and CT were developed to predict the risk of severe/serious injury and death.

After the experiment, a total of 87 goats were classified as severe/serious lung injury through pathology, including 40 goats that died on the spot. High altitude, close distance, and right-side orientation exacerbated lung injury severity, with close distance being the primary cause of death. Lung coefficient, CT score, and volume exhibited excellent performance in distinguishing outcomes (AUC: 0.967, 0.925, and 0.924 for lethality; 0.944, 0.915, and 0.909 for severity, respectively), with no significant difference in diagnostic efficacy. Moderate correlations were observed between lung coefficient and CT score for severity (r=0.440; 0.480), with a strong correlation for survival but none for death. Volume emerged as the primary risk factor, and the nomograms incorporating multiple factors demonstrated personalized predictive abilities.

CT combined with altitude, distance, and orientation can effectively predict the lethality and severity of primary blast lung injury, providing significant value for accurate injury assessment and clinical management.