Injury severity and causes of death from operation Iraqi freedom and operation enduring freedom: 2003-2004 versus 2006
Injury severity and causes of death from operation Iraqi freedom and operation enduring freedom: 2003-2004 versus 2006
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DOI：
10.1097/ta.0b013e318160b9fb
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发表时间：
2008-02-01
影响因子：
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通讯作者：
Holcomb, John B.
中科院分区：
文献类型：
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作者：
Kelly, Joseph F.;Ritenour, Amber E.;Holcomb, John B.
背景：多次出动的临床医生普遍认为，在伊拉克和阿富汗遭受的伤害严重程度有所增加。为了不断改善战斗伤亡护理，国防部制定了许多基于证据的政策和临床实践指南。我们假设伤口的严重程度随着时间的推移而增加。此外，我们还检查了死亡原因，寻找改进研究和培训的机会。方法：对伊拉克和阿富汗最早的战斗死亡人员以及 2006 年最新的死亡人员进行尸检分析，以评估受伤严重程度和死亡原因的变化。死亡人数被分为无法生存（NS）或潜在生存（PS）。然后深入回顾PS死亡，分析机制和原因。结果：符合纳入标准的2003年3月至2004年4月（第1组）有486例，2006年6月至2006年12月有496例（第2组）。在 PS 死亡人数中（第 1 组：93 例，第 2 组：139 例），第一组的损伤严重程度评分较低（27 +/- 14 与 37 +/- 16，p < 0.001），并且缩写损伤评分 >= 4 的数量也较少（每人 1.1 +/- 0.79 与 1.5 +/- 0.83，p < 0.001）。 PS 死亡病例中的主要原因是躯干出血（51% vs. 49%，p = NS）。各组之间每月的死亡人数增加了一倍（35 人对 71 人），而两个时间段之间的病死率相当（11.0 人对 9.8，p = NS）。讨论：在研究的战争时期，每月死亡人数增加了一倍，伤害严重程度和每名伤亡人数都增加。躯干出血是可能存活的死亡的主要原因。可以说，这场战争期间医疗改善的成功有助于维持有记录以来的最低病死率。
Background: The opinion that injuries sustained in Iraq and Afghanistan have increased in severity is widely held by clinicians who have deployed multiple times. To continuously improve combat casualty care, the Department of Defense has enacted numerous evidence-based policies and clinical practice guidelines. We hypothesized that the severity of wounds has increased over time. Furthermore, we examined cause of death looking for opportunities of improvement for research and training.Methods: Autopsies of the earliest combat deaths from Iraq and Afghanistan and the latest deaths of 2006 were analyzed to assess changes in injury severity and causes of death. Fatalities were classified as nonsurvivable (NS) or potentially survivable (PS). PS deaths were then reviewed in depth to analyze mechanism and cause.Results: There were 486 cases from March 2003 to April 2004 (group 1) and 496 from June 2006 to December 2006 (group 2) that met inclusion criteria. Of the PS fatalities (group 1: 93 and group 2: 139), the injury severity score was lower in the first group (27 +/- 14 vs. 37 +/- 16, p < 0.001), and had a lower number of abbreviated injury scores >= 4 (1.1 +/- 0.79 vs. 1.5 +/- 0.83 per person, p < 0.001). The main cause of death in the PS fatalities was truncal hemorrhage (51% vs. 49%, p = NS). Deaths per month between groups doubled (35 vs. 71), whereas the case fatality rates between the two time periods were equivalent (11.0 vs. 9.8, p = NS).Discussion: In the time periods of the war studied, deaths per month has doubled, with increases in both injury severity and number of wounds per casualty. Truncal hemorrhage is the leading cause of potentially survivable deaths. Arguably, the success of the medical improvements during this war has served to maintain the lowest case fatality rate on record.