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Military Occupational Blast Exposure: Definition, Operationalization, and Validation of a Reproducible Risk
Sarah L Martindale1, Jared A Rowland, Jennifer N Belding
1Author Affiliations: Salisbury VA Healthcare System, Salisbury, North Carolina (Martindale and Rowland); VISN-6 Mid-Atlantic MIRECC, Durham, North Carolina (Martindale and Rowland); Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem, North Carolina (Martindale and Rowland); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD (Belding). Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT (Amuan, Kennedy, Nguyen, and Pugh); Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT (Amuan, Kennedy, Nguyen and Pugh); VA Brain Health Coordinating Center (Brenner and Cifu); University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Brenner); Department of Nephrology, Uniformed Services University of the Health Sciences, Bethesda, MD (Stewart); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA (Cifu); and Central Virginia Veteran Healthcare System, Richmond Veterans Affair Medical Center, Richmond, VA (Cifu).
A new Military Occupational Blast Exposure (MOBE) risk classification system identifies high-risk occupations. This practical approach aids in understanding blast exposure and injury patterns when individual data is limited.
Area of Science:
- Military medicine
- Neuroscience
- Occupational health
Background:
- Blast exposure is a significant concern for military personnel.
- Quantifying cumulative blast exposure is challenging due to data limitations.
- Standardized methods are needed to assess occupational blast risk.
Purpose of the Study:
- To define Military Occupational Blast Exposure (MOBE) as a standardized construct.
- To propose reproducible MOBE risk classification groups based on military occupations.
- To enable risk assessment when objective exposure data is unavailable.
Main Methods:
- Utilized data from two LIMBIC-CENC studies (retrospective and prospective longitudinal).
- Operationalized MOBE risk classification using a large cohort (Phenotype Study).
- Validated MOBE risk classification against blast exposure metrics and TBI history in a prospective cohort (PLS).
Main Results:
- Classified 31.1% of military occupations as high-risk MOBE (MOBE+).
- MOBE+ individuals showed significantly higher rates of reported blast TBI history (43.7% vs. 27.0%) and exceeded GBEV thresholds.
- MOBE+ classification aligned with higher blast exposure scores and demonstrated occupational heterogeneity.
Conclusions:
- MOBE risk classification effectively differentiates blast exposure and injury patterns.
- MOBE provides a practical, scalable, and standardized method for estimating occupational blast exposure risk.
- This approach enhances study comparability when detailed individual exposure histories are absent.
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