Combat Wounds in Operation Iraqi Freedom and Operation Enduring Freedom

Owens, Brett D.; Kragh, John F; Wenke, Joseph C.; Macaitis, Joseph; Wade, Charles E.; Holcomb, John B.

doi:10.1097/ta.0b013e318163b875

Cited by 861 publications

(566 citation statements)

References 12 publications

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“…However, when focused specifically on colorectal trauma, GSWs are the predominant wounding modality. 4,[11][12][13][14]23,24 In the current study, GSW was found to be an independent risk factor for fecal diversion on multivariate analysis. Conversely, blast injury was not found to be an independent risk factor for colostomy.…”

Section: Discussionmentioning

confidence: 88%

Risk factors for colostomy in military colorectal trauma: A review of 867 patients

Watson¹,

Aden²,

Engel³

et al. 2014

Surgery

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Background. Limited data exist examining the use of fecal diversion in combatants from modern armed conflicts. Characterization of factors leading to colostomy creation is an initial step toward optimizing and individualizing combat casualty care. Methods. A retrospective review of the US Department of Defense Trauma Registry database was performed for all US and coalition troops with colorectal injuries sustained during combat operations in Iraq and Afghanistan over 8 years. Colostomy rate, anatomic injury location, mechanism of injury, demographic data, and initial physiologic parameters were examined. Univariate and multivariate analyses were conducted. Results. We identified 867 coalition military personnel with colorectal injuries. The overall colostomy rate was 37%. Rectal injuries had the highest diversion rate (56%), followed by left-sided (41%) and right-sided (20%) locations (P < .0001). Those with gunshot wounds (GSW) underwent diversion more often than blast injuries (43% vs 31% respectively, P < .0008). Injury Severity Score $16 (41% vs 30%; P = .0018) and damage control surgery (DCS; 48.2% vs 31.4%; P < .0001) were associated with higher diversion rates. On multivariate analysis, significant predictors for colostomy creation were injury location: Rectal versus left colon (odds ratio [OR], 2.2), rectal versus right colon (OR, 7.5), left versus right colon (OR, 3.4), GSW (OR, 2.0), ISS $ 16 (OR, 1.7), and DCS (OR, 1.6). Conclusion. In this exploratory study of 320 combat-related colostomies, distal colon and rectal injuries continue to be diverted at higher rates independent of other comorbidities. Additional outcomes-directed research is needed to determine whether such operative management is beneficial in all patients. (Surgery 2014;155:1052-61.)

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Section: Discussionmentioning

confidence: 88%

Risk factors for colostomy in military colorectal trauma: A review of 867 patients

Watson¹,

Aden²,

Engel³

et al. 2014

Surgery

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“…Additional study in military and civilian settings is needed to refine protocols for antibiotic prophylaxis on the battlefield. Another ongoing challenge is the need to deal with injuries from high-velocity weapons and IEDs, which result in complex, deep wounds, burns, and blunt trauma and represent more than of all wounds, according to the Joint Theatre Trauma Registry [108].…”

Section: Discussionmentioning

confidence: 99%

Treatment of War Wounds: A Historical Review

Manring

Hawk

Calhoun

et al. 2009

Clinical Orthopaedics &Amp; Related Research

139

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The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.

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“…A recent study of combat wounds treated at U.S. military medical facilities showed that the proportion of head and neck injuries was higher for OIF/OEF than for prior wars and more than 75 percent of wounds were due to blasts [10]. Almost 50 percent of head and neck injuries were attributable to improvised explosive devices and more than half of combat injuries requiring medical evacuation were due to blasts [11].…”

Section: Introductionmentioning

confidence: 99%

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

Pogoda¹,

Hendricks²,

Iverson³

et al. 2012

JRRD

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Abstract-With the use of Veterans Health Administration and Department of Defense databases of veterans who completed a Department of Veterans Affairs comprehensive traumatic brain injury (TBI) evaluation, the objectives of this study were to (1) identify the co-occurrence of self-reported auditory, visual, and vestibular impairment, referred to as multisensory impairment (MSI), and (2) examine demographic, deployment-related, and mental health characteristics that were potentially predictive of MSI. Our sample included 13,746 veterans with either a history of deployment-related mild TBI (mTBI) (n = 9,998) or no history of TBI (n = 3,748). The percentage of MSI across the sample was 13.9%, but was 17.4% in a subsample with mTBI history that experienced both nonblast and blast injuries. The factors that were significantly predictive of reporting MSI were older age, being female, lower rank, and etiology of injury. Deployment-related mTBI history, posttraumatic stress disorder, and depression were also significantly predictive of reporting MSI, with mTBI history the most robust after adjusting for these conditions. A better comprehension of impairments incurred by deployed servicemembers is needed to fully understand the spectrum of blast and nonblast dysfunction and may allow for more targeted interventions to be developed to address these issues.

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Combat Wounds in Operation Iraqi Freedom and Operation Enduring Freedom

Cited by 861 publications

References 12 publications

Risk factors for colostomy in military colorectal trauma: A review of 867 patients

Risk factors for colostomy in military colorectal trauma: A review of 867 patients

Treatment of War Wounds: A Historical Review

Multisensory impairment reported by veterans with and without mild traumatic brain injury history

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