Accession Number : ADA614882


Title :   Anatomic Distribution and Mortality of Arterial Injury in the Wars in Afghanistan and Iraq with Comparison to a Civilian Benchmark


Descriptive Note : Journal article


Corporate Author : ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX


Personal Author(s) : Markov, Nickolay P ; DuBose, Joseph J ; Scott, Daniel ; Propper, Brandon W ; Clouse, W D ; Thompson, Billy ; Blackbourne, Lorne H ; Rasmussen, Todd E


Full Text : https://apps.dtic.mil/dtic/tr/fulltext/u2/a614882.pdf


Report Date : Sep 2012


Pagination or Media Count : 10


Abstract : Objective: The purpose of this study was to examine the anatomic distribution and associated mortality of combat-related vascular injuries comparing them to a contemporary civilian standard. Design: The Joint Trauma Theater Registry (JTTR) was queried to identify patients with major compressible arterial injury (CAI) and noncompressible arterial injury (NCAI) sites, and their outcomes, among casualties in Iraq and Afghanistan from 2003 to 2006. The National Trauma Data Bank (NTDB) was then queried over the same time frame to identify civilian trauma patients with similar arterial injuries. Propensity score-based matching was used to create matched patient cohorts from both populations for analysis. Results: Registry queries identified 380 patients from the JTTR and 7020 patients from the NTDB who met inclusion criteria. Propensity score matching for age, elevated Injury Severity Score (ISS;15), and hypotension on arrival (systolic blood pressure [SBP] 90) resulted in 167 matched patients from each registry. The predominating mechanism of injury among matched JTTR patients was explosive events (73.1%), whereas penetrating injury was more common in the NTDB group (61.7%). In the matched cohorts, the incidence of NCAI did not differ (22.2% JTTR vs 26.6% NTDB; P = .372), but the NTDB patients had a higher incidence of CAI (73.7% vs 59.3%; P = .005). The JTTR cohort was also found to have a higher incidence of associated venous injury (57.5% vs 23.4%; P = .001). Overall, the matched JTTR cohort had a lower mortality than NTDB counterparts (4.2% vs 12.6%; P = .006), a finding that was also noted among patients with NCAI (10.8% vs 36.4%; P = .008). There was no difference in mortality between matched JTTR and NTDB patients with CAI overall (2.0% vs 4.1%; P = .465), or among those presenting with Glasgow Coma Scale (GCS) 8 (28.6% vs 40.0%; P = 1.00) or shock (SBP 90; 10.5% vs 7.7%; P = 100).


Descriptors :   *ANATOMY , *ARTERIES , *WOUNDS AND INJURIES , CASUALTIES , COMPARISON , DEMOGRAPHY , MILITARY MEDICINE , MORTALITY RATE , STATISTICAL ANALYSIS , TRAUMA


Subject Categories : Anatomy and Physiology
      Medicine and Medical Research


Distribution Statement : APPROVED FOR PUBLIC RELEASE