Higher Chest Injury Mortality Linked to Better Transport of Wounded

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HOUSTON — Wounded patients with battlefield chest injuries sustained in Afghanistan and Iraq had higher mortality rates than did patients during the Korean and Vietnam wars, but that likely was because better transport and triage got more of the severely wounded to trauma centers for treatment than in the past conflicts.

Many of those soldiers — whether they survived or not — would have been ended up being killed in action in the past. Recent advances in prehospital care, rapid transport and protective equipment for combat personnel might have resulted in more severely-injured patients arriving alive at a field hospital or other medical facility, which contributed to increased mortality after admission.

In the Iraq and Afghanistan wars, the military has acquired the ability to move wounded patients to higher-level care centers in the United States “within days or weeks of injury, as opposed to weeks or months,” said Capt. Katherine M. Ivey, MD, a resident in general surgery at San Antonio Military Medical Center. “Just as an observer working in the medical field in the military, it’s amazing how quickly we’re getting these soldiers back home.”

Ivey presented the study on military trauma at the 2012 American College of Surgeons Annual Clinical Congress.1

For the study, trauma surgeons from the U.S. Army Institute of Surgical Research in Fort Sam Houston, TX, compared mortality rates from chest injuries in conflicts dating back to the Civil War, when 63% of such injuries resulted in death compared with 10% in World War II, 2% in Korea and 3% in Vietnam. In Iraq and Afghanistan, the rate of mortality from chest was 8.3%, according to the study which analyzed data from the Joint Trauma Theater Registry on military chest injuries from January 2003 to May 2011.

The study only looked at deaths of soldiers treated for their injuries and did not include those killed in action.

“We feel that these findings are likely a reflection of our ability to get more severely injured soldiers — who otherwise may have died on the battlefield — to a medical facility,” Ivey noted. “We have the capability now of moving sicker patients from theater to the United States that we didn’t have before.”

Of 2,049 chest injuries analyzed in the two conflicts, 70% occurred in Operation Iraqi Freedom. Most chest injuries were caused by penetrating trauma (61.5%) followed by blunt trauma (26.7%) and blast injuries (11.6%). Collapsed lung, pulmonary contusions and rib fractures were the most common thoracic injuries.

In all, 1,412 operations were performed at combat-support hospitals.

1. Ivey KM, White CE, Wallum TE, et al. Thoracic Injuries in U.S. Combat Casualties: A Review of Operation Enduring Freedom and Operation Iraqi Freedom. Presented at: American College of Surgeons Annual Clinical Congress. Chicago. 9-30- to 10-4, 2012.

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