A Comparison Between Patients Treated at a Combat Support Hospital in Iraq and a Level I Trauma Center in the United States

Abstract

Combat support hospitals (CSHs) function under adverse operational conditions, delivering care to diverse patients. Appropriate allocation of resources and training are dependent on accurate assessments of the populations' needs. This study compared two patient populations treated between December 2004 and November 2005, one from a CSH in Iraq, the other at a civilian Level I trauma center. The trauma registry at Oregon Health & Science University was queried to evaluate all trauma patients admitted during the study period. The medical databases of the CSH were retrospectively reviewed. Coalition (Co) patients were US soldiers, their allies, and support staff. Noncoalition (Non-Co) patients were Iraqi Army, Iraqi National Guard, enemy forces, and Iraqi civilians. One thousand fifty-four patients were admitted to the CSH. Four hundred sixty-five of 696 (67%) Co patients versus 143 of 358 (40%) Non-Co patients had disease-related diagnoses (p < 0.01). The remaining 446 patients had traumatic diagnoses; 231 (52%) of these were Co patients. The incidence of battle injury was 59% in Co patients versus 90% in Non-Co patients (p < 0.01). One thousand three hundred thirty-nine trauma patients were admitted to Oregon Health & Science University. Civilian patients were older, less likely to be men, and had higher Injury Severity Scale scores than Co and Non-Co patients. Non-Co patients had higher Injury Severity Scale score, longer lengths of stay, and underwent 2.5 times as many operations as Co patients. Of the civilian patients, 93% were injured by blunt mechanisms compared with 20% of combat victims (p < 0.01). Percentages of abdominal, thoracic, and vascular procedures were similar between the three groups, but combat victims had more soft tissue procedures and dressing changes. There were no differences in mortality. Although CSHs and civilian trauma centers treat significantly different patient populations, the operations performed and outcomes are similar. Non-Co patients consumed 2.5 times more operative resources than did Co patients at the CSH.