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Nonfatal motor vehicle related injuries among deployed US Service members

Characteristics, trends, and risks for limb amputations

Schweizer, Marc A. MBChB, MPH; Janak, Jud C. PhD; Graham, Brock MPH; Mazuchowski, Edward L. USAF, MC; Gurney, Jennifer M. MC, USA; Shackelford, Stacy A. USAF, MC; Stockinger, Zsolt T. MC, USN; Monchal, Tristan MC

Journal of Trauma and Acute Care Surgery: October 2019 - Volume 87 - Issue 4 - p 907–914
doi: 10.1097/TA.0000000000002436

BACKGROUND Motor vehicle-related (MVR) incidents are important causes of morbidity among deployed US service members (SMs). Nonbattle MVR injuries are usually similar to civilian MVR injuries, while battle MVR injuries are often unique due to the blast effects from precipitating explosive mechanisms. Our primary objective was to describe the characteristics and trends of nonfatal MVR injuries sustained by deployed US SMs. A second objective was to assess the association between mechanism of injury (i.e., explosive vs. nonexplosive) and limb amputation.

METHODS We conducted a retrospective cross-sectional analysis using data from the Department of Defense Trauma Registry collected from October 2001 to December 2018. Descriptive statistics were reported stratified by mechanism of injury (explosive vs. nonexplosive). The association between mechanism of injury and limb amputation was assessed using logistic regression models.

RESULTS There were 3,119 US casualties who sustained nonfatal MVR injuries, 2,380 (76.3%) SMs sustained nonexplosive MVR injuries while 739 (23.7%) sustained explosive MVR injuries. Of all MVR casualties, 2,085 (66.9%) were in Iraq or Syria and 1034 (33.1%) in Afghanistan. The annual prevalence of nonfatal MVR battle casualties was highest in Iraq and Syria from 2003 to 2009 and Afghanistan from 2009 to 2014, ranging overall 15 to 50 MVR casualties per 1,000 wounded in action. There were 92 limb amputations associated with MVR incidents. Compared with nonexplosive MVR mechanisms, explosive MVR mechanisms had higher association with limb amputation (adjusted odds ratio, 2.6; confidence interval, 1.7–3.9), even after adjusting for injury year and Injury Severity Score (AOR, 2.1; confidence interval: 1.4–3.4).

CONCLUSION Motor vehicle-related incidents are an important cause of injury in US military operations. Compared with nonexplosive MVR incidents, explosive MVR incidents result in more severe injuries, and have a higher associated risk of limb amputation. Continued efforts to improve injury prevention through protective equipment and medical training specific to MVR injuries are needed.

LEVEL OF EVIDENCE Prognostic and epidemiological study, Level III.

From the Defense Health Agency (M.A.S., J.C.J., B.G., E.L.M., J.M.G., S.A.S.), Combat Support-Joint Trauma System, Joint Base San Antonio Fort Sam Houston, San Antonio, Texas; Naval Medical Readiness Training Command Jacksonville (Z.T.S.), Jacksonville, Florida; and Sainte Anne Military Hospital (T.M.), Toulon, France.

Submitted: April 27, 2019, Revised: June 14, 2019, Accepted: June 18, 2019, Published online: July 8, 2019.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Marc A. Schweizer, MBChB, MPH, Defense Health Agency Falls Church, VA (ORCID: 0000-0002-3459-6477); email:

Online date: July 26, 2019

© 2019 Lippincott Williams & Wilkins, Inc.