Blastotrauma: Concept and development of the blast trauma severity scale (BTSS) for explosion-related injuries

Aim: This study set out to develop and substantiate the concept of blastotrauma as a distinct category of traumatic pathology, to introduce the Blast Trauma Severity Scale (BTSS) for evaluating the severity of explosion-related injuries, and to show how the scale can be applied clinically in patients with combat-related trauma.

Materials and Methods: The study followed a retrospective observational design, drawing on archived clinical records of patients with combat-related injuries treated between 2023 and 2025. A total of 70 patients with blast and explosion-associated trauma qualified for inclusion. To enable consistent severity grading, the Blast Trauma Severity Scale (BTSS) was developed around five domains: soft tissue injury, bone injury, neurovascular injury, internal organ injury, and physiological response.

Results: The study introduces blastotrauma as a complex pattern of morphological and physiological damage arising when explosive energy is transferred to human tissues. The BTSS delivers an integrated severity score from 0 to 20 points, organised into four grades. Assessment can be further refined by appending the dominant blast-injury mechanism descriptor (P/S/T/Q). Applying the scale to the study cohort confirmed that consistent, standardized stratification of blast injuries is achievable in clinical practice.

Conclusions: The blastotrauma concept and the BTSS classification offer a practical framework for standardized description of explosion-related injuries, clinical stratification of patients, and continued research in trauma and military medicine.