Evaluating evidence supporting the relevancy of 4 psi as a blast overpressure value associated with brain health and performance outcomes following low-level blast overpressure exposure

Evidence suggests that low-level blast (LLB) overpressure exposure from military heavy weapons training is associated with subclinical adverse brain health and performance (H &P) outcomes. Existing DOD safety policies related to blast overpressure exposure are not specific to LLB-related brain health effects. This study sought to synthesize the available literature and analyze the relevancy of a specific blast metric to LLB exposures and the manifestation of adverse brain H &P outcomes. A literature search yielded 311 unique articles, from which 220 were identified as human studies on LLB published from 2010 to 2021. After more exhaustive exclusion criteria were applied, 14 articles met the criteria for inclusion. Findings on brain H &P changes were examined in relation to quantified LLB measurements (e.g., peak overpressure) to identify trends. Overall, the included studies suggested that alterations of reaction time, a metric for neurocognitive performance, as well as symptom reporting can occur following cumulative LLB exposures above 4 psi (27.6 kPa). Biomarkers and neurosensory changes have not demonstrated consistent associations with LLB exposures. These findings suggest that cumulative blast overpressure exposures above 4 psi (27.6 kPa) based on current measurement methodologies for body-worn sensors may be associated with adverse brain H &P outcomes. Current research efforts seek to better quantify LLB exposure, the relationships between LLB (e.g., intensity, duration, dose) and brain health, as well as to assess brain H &P domains more comprehensively. These efforts will serve to promote a better understanding of the interaction between LLB exposures and adverse brain H &P outcomes.