More Battlefield Casualties Reach the OR Alive

A new study of chest wounds in soldiers participating in the Iraq and Afghanistan conflicts indicates that improved battlefield triage may raise survival rates for severely wounded soldiers.

Researchers from the US Army Institute of Surgical Research (Fort Sam Houston, TX, USA) analyzed data from the Joint Trauma Theater Registry for US soldiers who sustained a chest injury in Iraq and Afghanistan from January 2003 to May 2011, and compared mortality rates from chest injuries in previous conflicts. Compared to the Civil War, when 63% of such injuries resulted in death, 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%, and did not include soldiers killed in action.

The researchers found that of 2,049 chest injuries analyzed in the two conflicts, 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. The researchers found that advances in prehospital care, rapid transport, and protective equipment for combat personnel have resulted in more severely injured patients arriving alive at a field hospital or other medical facility, which contributed to the increased mortality in the OR after admission.

While the study did not analyze specific triage factors that contributed to improved survivability of battlefield wounded, the use of helicopters and fixed-wing aircraft and the ability to transport wounded patients to higher-level care centers in the United States within days or weeks of injury, as opposed to weeks or months in previous conflicts, could have been an influencing factor. The study was presented at the American College of Surgeons (ACS) annual clinical congress, held during in September-October 2012 Chicago (IL, USA).

“We feel that these findings are likely a reflection of our ability to get more severely injured soldiers--whom otherwise may have died on the battlefield--to a medical facility,” said lead author and study presenter Captain Katherine Ivey, MD, a resident in general surgery at the San Antonio Military Medical Center (TX, USA). “We have the capability now of moving sicker patients from theater to the United States that we didn’t have before; it’s amazing how quickly we’re getting these soldiers back home.”

Specific types of chest trauma include injuries to the chest wall, such as contusions, hematomas, and fractures of the ribs, sternum, or shoulder girdle; pulmonary injuries involving the pleural space, such as pulmonary laceration, Pneumothorax, or Hemothorax; injury to the airways; cardiac injuries such as tamponade and traumatic cardiac arrest; blood vessel injuries such as aortic rupture or dissection; and damage to the esophagus or diaphragm.

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US Army Institute of Surgical Research