Analysis of battlefield head and neck injuries in iraq and afghanistan

Abstract

Objectives: Patterns of current combat injury are examined using data collected from the U.S. Army Combat Trauma Registry (CTR) and records from 2 major military hospitals. Prevalence of sites of injury are reported and compared to historical norms to identify significant changes in anatomic distribution. Methods: A retrospective review of patients treated for injuries sustained in combat operations in Afghanistan and Iraq from September 11 2001 to January 1 2004 was conducted. Over 28,000 patients were identified by the CTR and reviewed for abstraction and ICD-9 coding. At Landstuhl Hospital(Ramstein, Germany), 10,912 patients were evaluated and managed (2759 inpatient/8153 outpatient). At Walter Reed Medical Center (Washington, DC), 2150 patients were evaluated and managed. Combat mortality data from the Armed Forces Institute of Pathology (AFIP) were also analyzed. Results: Extremity injuries were most common (52%), followed by head and neck injuries (26%). Torso injuries accounted for only 7% of combat injuries. Analysis of combat fatalities revealed that head and neck wounds accounted for 64% of deaths. The mechanism of injury was explosive in 65.6%, gunshot wounds in 13.5%, blunt trauma in 11.5%, and unknown in 9.4%. Conclusions: Improved body armor and emerging enemy tactics have resulted in a distinctly new pattern of combat injury. Unprotected areas (ie, extremities and head and neck) account for the majority of injuries. Extremity injuries are generally not fatal. Unfortunately, wounds to unprotected regions of the head and neck account for the majority of combat deaths. These findings should be used to improve the planning and delivery of combat medical care.