Comparison of Military and Civilian Methods for Determining Potentially Preventable Deaths

Janak, Jud C.; Sosnov, Jonathan A.; Bares, Joan; Stockinger, Zsolt T.; Montgomery, Harold R; Kotwal, Russ S; Butler, Frank K.; Shackelford, Stacy; Gurney, Jennifer M; Spott, Mary Ann; Finelli, Louis N.; Mazuchowski, Edward L.; Smith, David J.

doi:10.1001/jamasurg.2017.6105

Cited by 28 publications

(19 citation statements)

References 73 publications

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“…The use of multidisciplinary expert panel reviews is considered the most robust approach to reviewing potentially preventable trauma deaths [14,15]. Despite this, contemporary expert panel reviews of prehospital trauma deaths are rare.…”

Section: Introductionmentioning

confidence: 99%

Potentially preventable trauma deaths: A retrospective review

Beck

Smith

Mercier

et al. 2019

Injury

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Section: Introductionmentioning

confidence: 99%

Potentially preventable trauma deaths: A retrospective review

Beck

Smith

Mercier

et al. 2019

Injury

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“…Paramount is determining which injury or constellation of injuries consistently fit criteria for survivability. Determination of injury survivability has traditionally been based on subject matter expert opinion, physiologic injury severity, and/or anatomic injury severity 6 . However, 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.…”

Section: Introductionmentioning

confidence: 99%

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

Janak

Mazuchowski

Kotwal

et al. 2019

Sci Rep

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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.

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“…This included prehospital and hospital health records, autopsies, and casualty status reports. Methodology, taxonomy, and standardized lexicon previously established by the military trauma mortality review process were used to classify and subcategorize fatalities, [9][10][11][12][13][14][15][16][17] with the explicit methodology used outlined by Janak et al 14 Eligible for study was any US military fatality that resulted from an injury or illness incurred during the course of OND, from September 2010 to December 2011. A separate military trauma mortality review of the subcategory of fatalities who died from nonsuicide trauma was also conducted.…”

Section: Methodsmentioning

confidence: 99%

United States military fatalities during Operation New Dawn

Mazuchowski

Janak

Howard

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Military operations vary by scope, purpose, and intensity, each having unique forces and actions to execute a mission. Evaluation of military operation fatalities guides current and future casualty care. METHODS:A retrospective study was conducted of all US military fatalities from Operation New Dawn in Iraq, 2010 to 2011. Data were obtained from autopsies and other records. Population characteristics, manner of death, cause of death, and location of death were analyzed. All fatalities were evaluated for concomitant evidence of underlying atherosclerosis. Nonsuicide trauma fatalities were also reviewed for injury severity, mechanism of death, injury survivability, death preventability, and opportunities for improvement. RESULTS:Of 74 US military Operation New Dawn fatalities (median age, 26 years; male, 98.6%; conventional forces, 100%; prehospital, 82.4%) the leading cause of death was injury (86.5%). The manner of death was primarily homicide (55.4%), followed by suicide (17.6%), natural (13.5%), and accident (9.5%). Fatalities were divided near evenly between combatants (52.7%) and support personnel (47.3%), and between battle injury (51.4%) and disease and nonbattle injury (48.6%). Natural and suicide death was higher (p < 0.01, 0.02) among support personnel who were older (p = 0.05) with more reserve/national guard personnel (p = 0.01). Total population prevalence of underlying atherosclerosis was 18.9%, with more among support personnel (64.3%). Of 46 nonsuicide trauma fatalities, most died of blast injury (67.4%) followed by gunshot wound (26.1%) and multiple/blunt force injury (6.5%).The leading mechanism of death was catastrophic tissue destruction (82.6%). Most had nonsurvivable injuries (82.6%) and nonpreventable deaths (93.5%). CONCLUSION:Operation New Dawn fatalities were exclusively conventional forces divided between combatants and support personnel, the former succumbing more to battle injury and the latter to disease and nonbattle injury including self-inflicted injury. For nonsuicide trauma fatalities, none died from a survivable injury, and 17.4% died from potentially survivable injuries. Opportunities for improvement included providing earlier blood products and surgery.

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Comparison of Military and Civilian Methods for Determining Potentially Preventable Deaths

Cited by 28 publications

References 73 publications

Potentially preventable trauma deaths: A retrospective review

Potentially preventable trauma deaths: A retrospective review

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

United States military fatalities during Operation New Dawn

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