Infections Complicating the Care of Combat Casualties During Operations Iraqi Freedom and Enduring Freedom
BROOKE ARMY MEDICAL CENTER FORT SAM HOUSTON TX
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Continued assessment of casualty complications, such as infections, enables the development of evidence-based guidelines to mitigate excess morbidity and mortality. We examine the Joint Theater Trauma Registry JTTR for infections and potential risk factors, such as transfusions, among Iraq and Afghanistan trauma patients. JTTR entries from deployment-related injuries with completed records between March 19, 2003, and April 13, 2009, were evaluated using International Classification of Diseases-9 codes for infections defined by anatomicclinical syndromes andor type of infecting organisms. Risk factors included mechanisms of injury, patient demographics, Injury Severity Score ISS, and transfusion, including massive transfusions 10 units of packed red blood cells. We reviewed 16,742 patients entries 15,021 from Operation Iraqi Freedom 9,883 battle injuries BI and 1,721 from Operation Enduring Freedom 1,090 BI. A total of 96.6 were men and 77.6 were Army personnel. The majority of BI were due to explosive devices 36.3. There were 921 patients 5.5 who had one or more infection codes with only 111 0.6 recorded deaths 16 with infections. Infections were commonly gram-negative bacteria 47.6 involving skinwound infections 26.7, and lung infections 14.6. Risk factors or associations that were most notable in univariate and multivariate analysis were calendar year of trauma, ISS, and pattern of injury. Conclusion The 5.5 infection rate is consistent with previous military and civilian trauma literature however, with the limitations of the JTTR, the infection rate is likely an underrepresentation due to inadequate level V and long-term infectious complications data. Combat operational trauma is primarily associated with gram-negative bacteria typically involving infections of wounds or other skin structures and lung infections such as pneumonia.
- Medicine and Medical Research