Diagnostic accuracy of blast-induced traumatic brain injury: a systematic review and meta-analysis

The purpose of this review was to systematically evaluate the existing diagnostic approaches of primary blast-induced brain injury through meta-analysis.

A systematic review and meta-analysis were conducted in PubMed, Web of Science, Cochrane Library, and Defense Technical Information Center databases. Reference lists from the 15 identified studies mainly focused on clinical interviews, vestibular/ocular motor screening tools, neuroimaging, and non-specific biomarkers. Univariate meta-regression and subgroup analyses were employed to identify the sources of heterogeneity.

This meta-analysis demonstrated high diagnostic accuracy in included studies, the pooled sensitivity, specificity and AUC were 0.93 [95%CI: 0.81-0.97], 0.90 [95%CI: 0.80-0.95] and 0.96 [95%CI: 0.94-0.98], respectively. However, the choice of diagnostic tools should take clinical practice scenarios into consideration. Biomarker-based and neuroimaging approaches both achieved good diagnostic accuracy but were inaccessible in acute, resource-constrained battlefield scenarios. VOMS-based assessment may be more suitable for front-line and field use. Among structured clinical review tools, the BATL-2 instrument performed best in identifying primary blast-related TBI.

Our findings demonstrate high diagnostic accuracy in the existing diagnostic methods for primary bTBI. However, each methods shows distinct applicability in different clinical scenarios. Much effort should be devoted to developing rapid, non-invasive and precise diagnostic approaches of primary bTBI in emergency settings.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420261281668; identifier: CRD420261281668.