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Thoracic trauma in Iraq and Afghanistan

Keneally, Ryan MD; Szpisjak, Dale MD, MPH

Journal of Trauma and Acute Care Surgery: May 2013 - Volume 74 - Issue 5 - p 1292–1297
Original Articles

BACKGROUND: Thoracic injuries are common among civilian trauma and have a high associated mortality. The use of body armor and exposure to different mechanisms of injury in combat setting could lead to different injury patterns and incidences from those found in peacetime.

METHODS: Thoracic trauma incidence rates and mortality risks were calculated from data extracted from the Joint Theatre Trauma Registry.

RESULTS: Among patients injured in military operations in Iraq and Afghanistan, 10.0% sustained thoracic injuries and had a mortality rate of 10.5%. Penetrating injuries were the most common mechanism of injury. The most common thoracic injury was pulmonary contusion. The highest mortality rate was in the subset of patients with thoracic vascular injuries or flail chest. The variables most strongly associated with mortality were number of units of blood transfused, admission base deficit, international normalization ratio, pH, Abbreviated Injury Scale scores for head and neck regions, and Injury Severity Score. Blunt injuries had the same mortality risk as penetrating injuries.

CONCLUSION: Combat-related thoracic trauma is common and associated with significant mortality in Iraq and Afghanistan.

LEVEL OF EVIDENCE: Prognostic study, level III.

From the Department of Anesthesiology Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Submitted: October 1, 2012, Revised: January 4, 2013, Accepted: January 4, 2013.

Limited amount of data presented on a poster in the American Society of Anesthesiology Annual Meeting, Washington, District of Columbia, October 2012.

Address for reprints: Ryan Keneally, MD, Department of Anesthesiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; email:

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army, Navy, or Defense.

© 2013 Lippincott Williams & Wilkins, Inc.