Citation

Stannard A, Morrison JJ, Scott DJ, Ivatury RA, Ross JD, Rasmussen TE. J. Trauma Acute Care Surg. 2013; 74(3): 830-834.

Affiliation

From the Academic Department of Military Surgery and Trauma (A.S., J.J.M.), Royal Centre for Defence Medicine, Birmingham, United Kingdom; US Army Institute of Surgical Research (J.J.M., D.J.S., R.A.I., T.E.R.), Fort Sam Houston; 59th Medical Deployment Wing (D.J.S., J.D.R., T.E.R.), Science and Technology Section, Lackland Air Force Base, San Antonio, Texas; and The Norman M. Rich Department of Surgery (T.E.R.), the Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0b013e31827a3704

PMID

23425743

Abstract

BACKGROUND: Noncompressible torso hemorrhage (NCTH) is the leading cause of potentially survivable trauma in the battlefield and has recently been defined using anatomic and physiologic criteria. The objective of this study was to characterize the frequency and mortality in combat of NCTH using a contemporary definition. METHODS: Four categories of torso injury, each based on vascular disruption, were identified in US military casualties from the Department of Defense Trauma Registry (2002-2010): (1) thoracic, including lung; (2) solid organ (high-grade spleen, liver, and kidney); (3) named axial vessel; and (4) pelvic fracture with ring disruption. Injuries within these categories were evaluated in the context of physiologic indicator of shock and/or the need for operative hemorrhage control. RESULTS: Of 15,209 battle injuries sustained during the study period, 12.7% (n = 1,936) had sustained one or more categories of torso injury. Of these, 331 (17.1%) had evidence of shock or the need for urgent hemorrhage control, with a mean (SD) Injury Severity Score (ISS) and mortality rate of 30 (13) and 18.7%, respectively. Pulmonary injuries were most numerous (41.7%), followed by solid-organ (29.3%), vascular (25.7%), and pelvic (15.1%) injuries. Following multivariate analysis, the most mortal injury complexes were identified as major arterial injury (odds ratio, 3.38; 95% confidence interval, 1.17-9.74) and pulmonary injury (odds ratio, 2.23; 95% confidence interval, 1.23-4.98). CONCLUSION: NCTH can be defined using anatomic parameters combined with physiologic and operative interventions suggestive of hemorrhage. Major arterial and pulmonary injuries contribute most significantly to the mortality burden. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.

Language: en