Comprehensive analysis of combat casualty outcomes in US service members from the beginning of World War II to the end of Operation Enduring Freedom
Comprehensive analysis of combat casualty outcomes in US service members from the beginning of World War II to the end of Operation Enduring Freedom
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DOI：
10.1097/ta.0000000000002789
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发表时间：
2020-08-01
影响因子：
3.4
通讯作者：
Schwab, C. William
中科院分区：
文献类型：
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作者：
Cannon, Jeremy W.;Holena, Daniel N.;Schwab, C. William
过去二十年来，战斗伤亡护理方面的进步提高了战斗生存能力。然而，在过去 80 年的战斗伤亡结果的更广泛背景下，这些结果仍然不完整。我们假设，从第二次世界大战开始，战斗生存能力在每次新冲突开始时都会恶化，但在冲突过程中会有所改善。为了评估战斗伤亡结果的长期趋势，我们对第二次世界大战、朝鲜冲突、越南冲突、伊拉克自由行动 (OIF) 和持久自由行动期间的每月战斗伤亡情况进行了整理。根据这些数字，我们计算了每月的病死率 (CFR)、阵亡人数 (% KIA) 和受伤死亡人数 (% DOW)。我们使用线性回归和 Loess 回归分析了这些指标，以了解每次冲突期间和冲突之间的显着趋势。然后，我们通过消除结果可变性来模拟替代结果场景。在这项综合分析中，研究期间 CFR 下降，KIA 百分比下降。然而，在研究个别冲突时，出现了一些不利的趋势，包括越南战争结束时所有死亡人数的激增以及韩国战争和 OIF 期间 DOW 百分比的上升。将每次冲突开始时的病死率与前一次冲突的最佳病死率进行比较时，在相对和平时期后，每次冲突都会出现高死亡率异常值，并且在第二次世界大战和越南战争中都出现了明显的“和平时期效应”。消除这些负面趋势以及随之而来的可预防的死亡将使 80 年来的战斗死亡人数减少 107,256 人（39.7%）。总之，尽管自第二次世界大战以来，战斗死亡率普遍有所改善，但仔细研究发现，冲突期间和冲突之间存在一些不利的趋势。识别这些趋势背后的因素将揭示未来改善战斗伤亡结果的更多机会。
Advances in combat casualty care have improved combat survivability over the past two decades. However, these outcomes remain incompletely framed in the broader context of combat casualty outcomes over the past 80 years. We hypothesized that starting with World War II, combat survival worsened at the beginning of each new conflict but then improved over the course of that conflict. To evaluate long-term trends in combat casualty outcomes, monthly combat injuries and deaths during World War II, the Korean conflict, the Vietnam conflict, Operation Iraqi Freedom (OIF), and Operation Enduring Freedom were collated. From these numbers, we calculated the monthly case fatality rate (CFR), the killed in action rate (% KIA), and the died of wounds rate (% DOW). We analyzed these metrics for significant trends during and between each conflict using linear and Loess regression. We then simulated alternate outcome scenarios by eliminating outcome variability. In this comprehensive analysis, CFR decreased over the study period in parallel with a decrease in% KIA. When examining individual conflicts, however, several unfavorable trends emerged including a spike in all fatality measures at the end of Vietnam and a rise in% DOW over the course of Korea and OIF. In comparing CFR at the beginning of each conflict to the best CFR from the prior conflict, high mortality outliers occurred in every conflict after a period of relative peace, and a clear “peacetime effect” occurred in both World War II and Vietnam. Eliminating these negative trends and the attendant preventable deaths would have reduced combat fatalities over the course of 80 years by 107,256 (39.7%). In summary, although combat mortality rates have generally improved since World War II, closer examination indicates several unfavorable trends both during and between conflicts. Identifying factors behind these trends will reveal further opportunities to improve combat casualty outcomes in the future.