Abdominal trauma surgery during recent US combat operations from 2002 to 2016

Stockinger, Zsolt T.; Turner, Caryn A.; Gurney, Jennifer M

doi:10.1097/ta.0000000000001804

Cited by 20 publications

(21 citation statements)

References 30 publications

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“…Besides fast and thorough wound debridement, this means mostly performing laparotomies, inserting chest tubes and amputations. These skills are crucial to save the patient's life [9,13]. They are also providing the basis for western surgeons dealing with an enormous number of casualties by a terror attack or a mass catastrophe [14,15].…”

Section: Pathway and Educationmentioning

confidence: 99%

War surgery in Afghanistan: a model for mass causalities in terror attacks?

Wichlas

Hofmann

Strada³

et al. 2020

International Orthopaedics (SICOT)

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Purpose The aim of the study was to identify solution strategies from a non-governmental (NGO) hospital in a war region for violence-related injuries and to show how high-income countries (HIC) might benefit from this expertise. Methods NGO trauma hospital in Lashkar Gah, Afghanistan. Four hundred eighty-four war victims admitted in a three month period (February 2016–May 2016) were included. Patients´ characteristics were analyzed. Results The mean age was 23.5 years. Four hundred thirty-four (89.9%) were male, and 50 (10.1%) were female. The most common cause of injury was bullet injuries, shell injuries, and mine injuries. The most common injured body region was the lower extremity, upper extremity, and the chest or the face. Apart from surgical wound care and debridements, which were performed on every wound in the operation theatre, laparotomy was the most common surgical procedure, followed by installation of a chest drainage and amputation. Conclusion The surgical expertise and clear pathways outweigh modern infrastructure. In case of a mass casualty incident, fast decision-making with basic diagnostic means in order to take rapid measurements for life-saving therapies could make the difference.

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Section: Pathway and Educationmentioning

confidence: 99%

War surgery in Afghanistan: a model for mass causalities in terror attacks?

Wichlas

Hofmann

Strada³

et al. 2020

International Orthopaedics (SICOT)

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“…A definition of an adequate number of cases for a general surgeon to be ‘proficient’ in trauma is undefined and ambiguous at best; there are little objective data to answer this question. Although arbitrary, and difficult to correlate with trauma readiness for deployment operations, 10-operative trauma was selected as an initial target for this to objectify a starting point, but expanded to include other possible totals 10–12. Despite being the number mandated by the ACGME for residency graduation, it is unlikely that this is the case volume which would result in a trained surgeon (in non-trauma practice) retooled for deployment.…”

Section: Discussionmentioning

confidence: 99%

“…For each surgical specialty examined, seasonality was tested for each institution and, where appropriate, further analysis was done to determine the anticipated number of days required to experience a certain number of cases and to estimate how many cases would be experienced during a specified number of days. Given there are little data to discern adequate case volume for a general surgeon to be ‘proficient’ in trauma, we chose 10 operative trauma cases as an initial benchmark, the number mandated by Accreditation Council for Graduate Medical Education (ACGME) for general surgery graduation, but considered other possible case volumes above and below this number 10–12. Additional case volume scenarios were analyzed, defining competency as exposure to ‘X’ cases per year, where ‘X’=5, 10, 12, or 20 cases, respectively.…”

Section: Methodsmentioning

confidence: 99%

Objective model to facilitate designation of military–civilian partnership hospitals for sustainment of military trauma readiness

Hall

Qureshi²,

Shackelford

et al. 2019

Trauma Surg Acute Care Open

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BackgroundA major dilemma of the military surgeon is the requirement for battlefield trauma expertise without regular exposure to a traumatically injured patient. To solve this problem, the military is partnering with civilian trauma centers to obtain the required trauma exposure. The main objective of this article is to quantify institutional differences and develop a predictive model for estimating the number of 24-hour trauma shifts a surgeon must be on call at civilian centers to experience urgent trauma cases.MethodsTrauma databases from multiple institutions were queried to obtain all urgent trauma cases occurring during a 2-year period. A predictive model was used to estimate the number of urgent surgical cases in multiple specialties surgeons would experience over various numbers of 24-hour shifts and the number of 24-hour shifts required to experience a defined number of cases.ResultsInstitution 1 had the lowest number of required 24-hour shifts to experience 10 urgent operative cases for general/trauma surgery (10 calls) and orthopedic surgery (6 calls) and the highest number of predicted cases over 12 days, 18.3 (95% CI 11 to 27), with 95% confidence. The expected trauma cases and 24-hour shifts at Institution 1 were statistically significant (p<0.0001). There were seasonal effects at all institutions except for Institution 3.DiscussionThere are significant variabilities in trauma center volume and therefore, the expected number of shifts and cases during a specific period of time is significantly different between trauma centers. This predictive model is objective and can therefore be used as an extrapolative tool to help and inform the military regarding placement of personnel in optimal centers for trauma currency rotations.Level of evidenceEconomic and value-based evaluations, level II.

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“…With the advancement of personal protective equipment, the occurrence of battlefield abdominal injuries has decreased when compared with prior wars; however, they still contribute approximately 10% of the battlefield injury burden. 6,7 Furthermore, abdominal surgery accounted for 13% of surgical procedures performed on combat casualties with the majority occurring in the operational combat theater. Specifically, exploratory laparotomy was noted as the most common abdominal surgical procedure performed within the combat zone.…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, exploratory laparotomy was noted as the most common abdominal surgical procedure performed within the combat zone. 7,8 Infections are well-recognized complications after abdominal trauma. Although intra-abdominal infections have been evaluated in civilian populations, [9][10][11][12] less information is available for battlefield abdominal trauma.…”

Section: Introductionmentioning

confidence: 99%