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Advances change care of battlefield chest injuries


Soldiers who sustained chest injuries in Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom had higher mortality rates than soldiers in Korea and Vietnam, according to a military trauma study.

However, better battlefield triage and transport may have meant that severely wounded soldiers, who would have been considered killed in action in previous conflicts, were more likely to get sent to trauma centers in the United States sooner in their course of care, the study authors said.

Trauma surgeons from the U.S. Army Institute of Surgical Research in Fort Sam Houston, Texas, studied 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. The rate of mortality from chest injuries in Iraq and Afghanistan was 8.3%.

The researchers focused on injuries of the thorax and analyzed data from the Joint Trauma Theater Registry for U.S. soldiers who sustained a chest injury in Iraq and Afghanistan from January 2003 to May 2011. The analysis did not include soldiers killed in action.

The surgeons concluded that advances in prehospital care, rapid transport and protective equipment for combat personnel may have allowed more severely injured patients to arrive alive at a field hospital or other medical facility, which contributed to increased mortality after admission.

“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,” Capt. Katherine M. Ivey, MD, a resident in general surgery at San Antonio Military Medical Center, said in a news release.

“We have the capability now of moving sicker patients from theater to the United States that we didn’t have before,” added Ivey, who presented the study at the American College of Surgeons’ 2012 congress in Chicago.

Although the study did not analyze specific transport factors that contributed to improved survivability, Ivey noted that the use of helicopters and fixed-wing aircraft long have played a role in evacuating battlefield wounded.

However, 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,” Ivey said. “Just as an observer working in the medical field in the military, it’s amazing how quickly we’re getting these soldiers back home.”

One observation from analyzing the study results may be applicable in civilian trauma care: “We have found that most penetrating fragmentation injuries of the thorax are managed solely with a tube thoracostomy as opposed to an actual thoracotomy,” Ivey said.

Of 2,049 chest injuries analyzed in the two conflicts, 70% occurred in Operation Iraqi Freedom (the researchers did not analyze why more chest injuries occurred in Iraq). Most chest injuries were caused by penetrating trauma (61.5%) followed by blunt trauma (26.7%) and blast injuries (11.6%). The most common thoracic injuries were collapsed lung, pulmonary contusions and rib fractures.

In all, 1,412 operations were performed at combat support hospitals, which provide a range of surgical and medical specialties and have ICUs.


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