Anatomic Distribution and Mortality of Arterial Injury in the Wars in Afghanistan and Iraq with Comparison to a Civilian Benchmark
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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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 ISS15, 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.
- Anatomy and Physiology
- Medicine and Medical Research