Patterns of Anatomic Injury in Critically Injured Combat Casualties: A Network Analysis

Jud C Janak,Jennifer M Gurney,Zsolt T Stockinger,Stacy A Shackelford,Jeffrey T Howard,Jonathan A Sosnov,Russ S Kotwal,Frank K Butler,Edward L Mazuchowski

doi:10.1038/s41598-019-50272-3

Abstract

A mortality review of death caused by injury requires a determination of injury survivability prior to a determination of death preventability. If injuries are nonsurvivable, only non-medical primary prevention strategies have potential to prevent the death. Therefore, objective measures are needed to empirically inform injury survivability from complex anatomic patterns of injury. As a component of injury mortality reviews, network structures show promise to objectively elucidate survivability from complex anatomic patterns of injury resulting from explosive and firearm mechanisms. In this network analysis of 5,703 critically injured combat casualties, patterns of injury among fatalities from explosive mechanisms were associated with both a higher number and severity of anatomic injuries to regions such as the extremities, abdomen, and thorax. Patterns of injuries from a firearm were more isolated to individual body regions with fatal patterns involving more severe injuries to the head and thorax. Each injury generates a specific level of risk as part of an overall anatomic pattern to inform injury survivability not always captured by traditional trauma scoring systems. Network models have potential to further elucidate differences between potentially survivable and nonsurvivable anatomic patterns of injury as part of the mortality review process relevant to improving both the military and civilian trauma care systems.

Highlights

Injury is the leading cause of death for US adults under the age of 451
Of 5,344 battle-related deaths identified by the Armed Forces Medical Examiner System (AFMES), a total of 4,320 fatalities met study inclusion criteria
Of 83,839 casualties identified in the Department of Defense Trauma Registry (DODTR), a total of 1,383 met study inclusion criteria

Summary

Introduction

Injury is the leading cause of death for US adults under the age of 451. Approximately 20% of these trauma deaths are considered potentially preventable[2,3]. A requirement for a better understanding of the association between survivability and whole-body patterns of anatomic injuries persists as traditional methods (1) do not fully account for the complexity of explosive and firearm polytraumatic injuries; (2) are overly reliant on an injury severity score (ISS) initially designed primarily for civilian motor vehicle crashes; and (3) inadvertently minimize the extent of damage by concentrating on isolated rather than whole-body patterns of anatomic injuries. To address these issues, and to gain a better understanding of survivability among fatalities and survivors, we investigated whole-body patterns of anatomic injuries among combat casualties using binary network analysis[7]

Methods

Results

Discussion

Conclusion