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Alcover KC, Howard K, Poltavskiy E, Derminassian AD, Nickel MS, Allard RJ, Dao B, Stewart IJ, Howard JT. Disease and Non-Battle Injury in Deployed Military: A Systematic Review and Meta-analysis. Mil Med 2024; 189:21-30. [PMID: 39160823 DOI: 10.1093/milmed/usae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/30/2023] [Accepted: 02/02/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Disease and non-battle injury (DNBI) has historically been the leading casualty type among service members in warfare and a leading health problem confronting military personnel, resulting in significant loss of manpower. Studies show a significant increase in disease burden for DNBI when compared to combat-related injuries. Understanding the causes of and trends in DNBI may help guide efforts to develop preventive measures and help increase medical readiness and resiliency. However, despite its significant disease burden within the military population, DNBI remains less studied than battle injury. In this review, we aimed to evaluate the recently published literature on DNBI and to describe the characteristics of these recently published studies. MATERIALS AND METHODS This systematic review is reported in the Prospective Register of Systematic Reviews database. The systematic search for published articles was conducted through July 21, 2022, in Cumulative Index of Nursing and Allied Health, Cochrane Library, Defense Technical Information Center, Embase, and PubMed. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses, the investigators independently screened the reference lists on the Covidence website (covidence.org). An article was excluded if it met any of the following criteria: (1) Published not in English; (2) published before 2010; (3) data used before 2001; (4) case reports, commentaries, and editorial letters; (5) systematic reviews or narrative reviews; (6) used animal models; (7) mechanical or biomechanical studies; (8) outcome was combat injury or non-specified; (9) sample was veterans, DoD civilians, contractors, local nationals, foreign military, and others; (10) sample was U.S. Military academy; (11) sample was non-deployed; (12) bioterrorism study; (13) qualitative study. The full-text review of 2 independent investigators reached 96% overall agreement (166 of 173 articles; κ = 0.89). Disagreements were resolved by a third reviewer. Study characteristics and outcomes were extracted from each article. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis of pooled estimates of incidence rates for disease (D), non-battle injury (NBI), and combined DNBI was created using random-effects models. RESULTS Of the 3,401 articles, 173 were included for the full review and 29 (16.8%) met all inclusion criteria. Of the 29 studies included, 21 (72.4%) were retrospective designs, 5 (17.2%) were prospective designs, and 3 (10.3%) were surveys. Across all studies, the median number of total cases reported was 1,626 (interquartile range: 619.5-10,203). The results of meta-analyses for 8 studies with reported incidence rates (per 1,000 person-years) for D (n = 3), NBI (n = 7), and DNBI (n = 5) showed pooled incidence rates of 22.18 per 1,000 person-years for D, 19.86 per 1,000 person-years for NBI, and 50.97 per 1,000 person-years for combined DNBI. Among 3 studies with incidence rates for D, NBI, and battle injury, the incidence rates were 20.32 per 1,000 person-years for D, 6.88 per 1,000 person-years for NBI, and 6.83 per 1,000 person-years for battle injury. CONCLUSIONS DNBI remains the leading cause of morbidity in conflicts involving the U.S. Military over the last 20 years. More research with stronger designs and consistent measurement is needed to improve medical readiness and maintain force lethality. LEVEL OF EVIDENCE Systematic Review and Meta-Analysis, Level III.
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Affiliation(s)
- Karl C Alcover
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Krista Howard
- Department of Psychology, Texas State University, San Marcos, TX 78666, USA
- Military & Health Research Foundation, Laurel, MD 20723, USA
| | - Eduard Poltavskiy
- Military & Health Research Foundation, Laurel, MD 20723, USA
- Travis AFB, David Grant USAF Medical Center, Fairfield, CA 94533, USA
| | | | | | - Rhonda J Allard
- James A. Zimble Learning Resource Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Bach Dao
- Military & Health Research Foundation, Laurel, MD 20723, USA
| | - Ian J Stewart
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Military Cardiovascular Outcomes Research (MiCOR), Bethesda, MD 20814, USA
| | - Jeffrey T Howard
- Military & Health Research Foundation, Laurel, MD 20723, USA
- Department of Public Health, University of Texas-San Antonio, San Antonio, TX 78249, USA
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The New Face of War: Craniofacial Injuries from Operation Inherent Resolve. J Trauma Acute Care Surg 2022; 93:S49-S55. [PMID: 35583970 DOI: 10.1097/ta.0000000000003700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION During the last 20 years of conflict in the Middle East, improvements in body armor and the use of improvised explosive devices has resulted in an increased incidence of complex craniofacial trauma (CFT). Currently, CFT comprises up to 40% of all casualties. We present new data from the recent conflict in Iraq and Syria during Operation Inherent Resolve. METHODS Data was collected for patients treated at Role 1, Role 2, and Role 3 facilities in Iraq and Syria over a one-year period. During this time, a specialized Head & Neck surgical augmentation team was deployed and co-located with the central Role 3 facility. Data included for this cross-sectional study: injury type and mechanism, triage category, initial managing facility and subsequent levels of care, and procedures performed. RESULTS Ninety-six patients sustained CFT over the study period. The most common injuries were soft tissue (57%), followed by cranial (44%) and orbital/facial (31%). Associated truncal and/or extremity injuries were seen in forty-six patients (48%). There were marked differences in incidence and pattern of injuries between mechanisms (Figure, all p < 0.05). While IEDs had the highest rate of cranial and truncal injuries, GSW and blunt mechanisms had higher incidences of orbital/facial and neck injuries. Overall, 45% required operative interventions including complex facial reconstruction, craniotomy, and open globe repair. Mortality was 6% with 83% due to associated severe brain injury. Most patients were local nationals (70%) who required discharge or transfer to the local healthcare system. CONCLUSION Complex craniofacial trauma is increasingly seen by deployed surgeons, regardless of subspecialty training or location. Deployment of a centrally located Head & Neck team greatly enhances the capabilities for forward deployed management of CFT, with excellent outcomes for both U.S. and local national patients. LEVEL OF EVIDENCE Level 4, retrospective study.
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Maj BC, Col MS, Capt MA. The Orthodontist's Role in Post-Battlefield Craniomaxillofacial Trauma Reconstruction. Mil Med 2022; 188:usac102. [PMID: 35415744 DOI: 10.1093/milmed/usac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/06/2022] [Accepted: 03/30/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In modern conflicts, deployed members are more vulnerable to craniomaxillofacial (CMF) injury than in previous conflicts. Patients presenting with CMF trauma are susceptible to post-trauma dental malocclusion and may require lengthy rehabilitation to achieve pre-injury function. This study surveyed military health care professionals who are potential contributors to CMF trauma rehabilitation teams to evaluate the orthodontist's inclusion in treating to the final outcome. METHODS Following approval from the Defense Health Agency Information Management Collections Office (Control Number: 9-DHA-1031-E) and the Air Force 59th Medical Wing Institutional Review Board (Reference Number: FWH20210061E), a survey study was conducted from April 2021 to July 2021. Volunteer participants were recruited from orthodontists, oral maxillofacial surgeons, medical specialists, and other dental specialists who have worked in military healthcare. Respondents reported their current practice treating CMF trauma, self-evaluated their knowledge of different aspects of the process, and submitted their perceptions on system and patient-limiting factors which affect outcomes. Descriptive statistics were conducted for ordinal data and chi-square tests for categorical data. Kruskal-Wallis analyses of variance compared cohorts with further Mann-Whitney U tests to distinguish the difference in cohorts. RESULTS Valid responses were collected from 171 participants. The responses were mostly from active duty military (93%) and well distributed among orthodontists, oral maxillofacial surgeons, other dental specialists, and medical specialists. When reporting current CMF trauma treatment practices, the majority of dental specialists stated they most commonly participate in a multidisciplinary team that addresses any CMF trauma case (68.4%) whereas medical specialists most commonly act as solo independent provider practice (53.6%). Dental specialists reported follow-up with post-trauma patients greater than 1 year and medical specialists reported the shortest post-trauma follow-up time with a median of 0 to 3 months. The majority of participants selected at least one system factor limiting CMF trauma care (78.7%) and at least one patient factor limiting CMF trauma care (86.3%). When asked about orthodontic participation in multidisciplinary teams, the responses showed a great range with orthodontists never included in CMF trauma care 23.1% of the time and always consulted regarding trauma cases 10.7% of the time. Other survey data collected allows the investigators to draw conclusions regarding specific limitations to treatment and recommendations for improvement, along with qualitative responses from survey participants. CONCLUSIONS Orthodontics, while available in the military, is underutilized in treating post-warfare or other CMF trauma. There are both system- and patient-limiting factors in the treatment of battlefield and non-battlefield CMF trauma. In addition, there are limitations to the inclusion of orthodontists in CMF trauma care which include the physical distance from primary treating specialists and the absence of standard referral protocols. Oral maxillofacial surgeons reported the highest understanding of the military orthodontist's contribution to a CMF trauma treatment team and medical specialists reported the lowest understanding. Advanced technology tools could help improve outcomes and multidisciplinary interactions. Further research is needed to study the complete CMF trauma rehabilitation process in military treatment facilities, evaluate the efficiency of cross-specialty referrals, and highlight best practices and protocols of functioning multidisciplinary teams.
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Affiliation(s)
- B Carter Maj
- Tri-Service Orthodontic Residency Program, Air Force Post-Graduate Dental School and Uniformed Services University of the Health Sciences Postgraduate Dental College, JBSA Lackland AFB, TX 78236, USA
| | - M Speier Col
- Clinical Dentistry, Air Force Medical Readiness Agency and Assistant Professor of Orthodontics, Uniformed Services University of the Health Sciences Postgraduate Dental College, Falls Church, VA 22042, USA
| | - M Anderson Capt
- Tri-Service Orthodontic Residency Program, Air Force Post-Graduate Dental School and Assistant Professor of Orthodontics, Uniformed Services University of the Health Sciences Postgraduate Dental College, JBSA Lackland AFB, TX 78236, USA
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Le TD, Gurney JM, Akers KS, Chung KK, Singh KP, Wang HC, Stackle ME, Pusateri AE. Analysis of Nonbattle Deaths Among U.S. Service Members in the Deployed Environment. Ann Surg 2021; 274:e445-e451. [PMID: 34238813 DOI: 10.1097/sla.0000000000005047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Describe etiologies and trends in non-battle deaths (NBD) among deployed U.S. service members to identify areas for prevention. BACKGROUND Injuries in combat are categorized as battle (result of hostile action) or nonbattle related. Previous work found that one-third of injured US military personnel in Iraq and Afghanistan had nonbattle injuries and emphasized prevention. NBD have not yet been characterized. METHODS U.S. military casualty data for Iraq and Afghanistan from 2001 to 2014 were obtained from the Defense Casualty Analysis System (DCAS) and the Department of Defense Trauma Registry (DoDTR). Two databases were used because DoDTR does not capture prehospital deaths, while DCAS does not contain clinical details. Nonbattle injuries and NBD were identified, etiologies classified, and NBD trends were assessed using a weighted moving average and time-series analysis with autoregressive integrated moving average. Future NBD rates were forecast. RESULTS DCAS recorded 59,799 casualties; 21.0% (n = 1431) of all deaths (n = 6745) were NBD. DoDTR recorded 29,958 casualties; 11.5% (n = 206) of all deaths (n = 1788) were NBD. After early fluctuations, NBD rates for both Iraq and Afghanistan stabilized at approximately 21%. Leading causes of NBD were gunshot wounds and vehicle accidents, accounting for 66%. Approximately 25% was self-inflicted. A 24% NBD rate was forecasted from 2015 through 2025. CONCLUSIONS Approximately 1 in 5 deaths were NBD. The majority were potentially preventable, including a significant proportion of self-inflicted injuries. A single comprehensive data repository would facilitate future mortality monitoring and performance improvement. These data may assist military leaders with implementing targeted safety strategies.
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Affiliation(s)
- Tuan D Le
- Research Directorate, U.S. Army Institute of Surgical Research, JBSA - Fort Sam Houston, Texas
- Department of Epidemiology and Biostatistics, School of Community and Rural Health, University of Texas Health Science Center at Tyler, Tyler, Texas
| | - Jennifer M Gurney
- Research Directorate, U.S. Army Institute of Surgical Research, JBSA - Fort Sam Houston, Texas
- Joint Trauma System, JBSA - Fort Sam Houston, Texas
| | - Kevin S Akers
- Research Directorate, U.S. Army Institute of Surgical Research, JBSA - Fort Sam Houston, Texas
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Karan P Singh
- Department of Epidemiology and Biostatistics, School of Community and Rural Health, University of Texas Health Science Center at Tyler, Tyler, Texas
| | - Heuy-Ching Wang
- Naval Medical Research Center, JBSA - Fort Sam Houston, Texas
| | - Mark E Stackle
- Research Directorate, U.S. Army Institute of Surgical Research, JBSA - Fort Sam Houston, Texas
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Craniofacial Trauma on the Modern Battlefield: Initial Management and Techniques. CURRENT TRAUMA REPORTS 2021. [DOI: 10.1007/s40719-021-00213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kauvar DS, Gurney J. Exploring Nonbattle Injury in the Deployed Military Environment Using the Department of Defense Trauma Registry. Mil Med 2021; 185:e1073-e1076. [PMID: 32147699 DOI: 10.1093/milmed/usz481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/09/2019] [Accepted: 12/31/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The impact of disease and nonbattle injury (DNBI) on casualty burden of military operations has historically been greater than that of battle-related injuries. The ratio of battle to DNBI casualties has changed as advances in equipment, hygiene, and infectious diseases have been made; however, during military operations in Iraq and Afghanistan, 30% of serious injuries treated or evacuated from the area of operations were secondary to NBI. Most DoD research and intervention efforts focus on battle injuries; NBI has received much less practical attention. We aimed to explore the potential utility of the largest Department of Defense casualty database in identifying potential intervention targets for preventing NBI events. MATERIALS AND METHODS Phase I was a comprehensive NBI literature review from historical and current military operations. Phase II was an IRB exempt initial examination of relevant data contained in the Department of Defense Trauma Registry (DoDTR). Phase I: A MEDLINE search using the terms "military", "injury", and "nonbattle/non battle" was performed, and articles containing useful data points to characterize the unique risks of the modern deployed military environment and identify potentially preventable NBI hazards in the modern deployed military environment were retrieved and reviewed in full-text. Phase II: This information was used to explore data within the DoDTR's and its ability to provide data to inform NBI prevention efforts in the following areas: most prevalent NBI causes, NBI location and timing related to operational tempo, characteristics of the population at risk for NBI. RESULTS Phase I: Falls and motor vehicle crashes (MVCs) accounted for most of the serious NBI in Iraq and Afghanistan. No specific epidemiologic data was readily available to guide NBI prevention efforts. Phase II was limited to NBI and falls from Iraq and Afghanistan in the DoDTR. Only aggregate data were available with a total of 1829 falls and 1899 MVCs. Case fatality for falls was 1.1% and for MVCs 6.5%. The greatest frequency of NBI was in Iraq among U.S. Army personnel, but comparison of rates is not possible without reliable denominators for individual variables. Annual NBI incidence seems proportional to overall level of personnel deployed to each theater, but without knowledge of the true denominator of total deployed personnel, it is impossible to conclude definitively. The annual number of falls was stable throughout the period of highest operational tempo in Iraq (2003-2011), although MVCs were more common earlier in the operation (2003-2005), likely corresponding to greater operational maneuver. CONCLUSIONS The deployed military environment is dangerous and NBI presents a primary prevention target for expeditionary operations. The DoDTR is a database of detailed injury and medical care information and lacks much of the data required to perform a comprehensive epidemiologic NBI analysis. Specific prevention recommendations cannot be made based solely on DoDTR data and integration with other DoD databases that assess operational and tactical data should be considered.
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Affiliation(s)
- David S Kauvar
- Vascular Surgery Service, Brooke Army Medical Center, JBSA Ft. Sam Houston, San Antonio, TX.,Department of Surgery, Uniformed Services University, Bethesda, MD
| | - Jennifer Gurney
- Department of Surgery, Uniformed Services University, Bethesda, MD.,Joint Trauma System, JBSA Ft. Sam Houston, San Antonio, TX
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Carlisle P, Marrs J, Gaviria L, Silliman DT, Decker JF, Brown Baer P, Guda T. Quantifying Vascular Changes Surrounding Bone Regeneration in a Porcine Mandibular Defect Using Computed Tomography. Tissue Eng Part C Methods 2020; 25:721-731. [PMID: 31850839 DOI: 10.1089/ten.tec.2019.0205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Angiogenesis is a critical process essential for optimal bone healing. Several in vitro and in vivo systems have been previously used to elucidate some of the mechanisms involved in the process of angiogenesis, and at the same time, to test potential therapeutic agents and bioactive factors that play important roles in neovascularization. Computed tomography (CT) is a noninvasive imaging technique that has recently allowed investigators to obtain a diverse range of high-resolution, three-dimensional characterization of structures, such as bone formation within bony defects. Unfortunately, to date, angiogenesis evaluation relies primarily on histology, or ex vivo imaging and few studies have utilized CT to qualitatively and quantitatively study the vascular response during bone repair. In the current study a clinical CT-based technique was used to evaluate the effects of rhBMP-2 eluting graft treatment on soft tissue vascular architecture surrounding a large segmental bone defect model in the minipig mandible. The objective of this study was to demonstrate the efficacy of contrast-enhanced, clinical 64-slice CT technology in extracting quantitative metrics of vascular architecture over a 12-week period. The results of this study show that the presence of rhBMP-2 had a positive effect on vessel volume from 4 to 12 weeks, which was explained by a concurrent increase in vessel number, which was also significantly higher at 4 weeks for the rhBMP-2 treatment. More importantly, analysis of vessel architecture showed no changes throughout the duration of the study, indicating therapeutic safety. This study validates CT analysis as a relevant imaging method for quantitative and qualitative analysis of morphological characteristics of vascular tissue around a bone healing site. Also important, the study shows that CT technology can be used in large animal models and potentially be translated into clinical models for the development of improved methods to evaluate tissue healing and vascular adaptation processes over the course of therapy. This methodology has demonstrated sensitivity to tracking spatial and temporal changes in vascularization and has the potential to be applied to studying changes in other high-contrast tissues as well. Impact Statement Tissue engineering solutions depend on the surrounding tissue response to support regeneration. The inflammatory environment and surrounding vascular supply are critical to determining if therapies will survive, engraftment occurs, and native physiology is restored. This study for the first time evaluates the blood vessel network changes in surrounding soft tissue to a bone defect site in a large animal model, using clinically available computed tomography tools and model changes in vessel number, size, and architecture. While this study focuses on rhBMP2 delivery impacting surrounding vasculature, this validated method can be extended to studying the vascular network changes in other tissues as well.
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Affiliation(s)
- Patricia Carlisle
- Dental Trauma and Research Detachment, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas.,Prytime Medical Devices, Inc., Boerne, Texas
| | - Jeffrey Marrs
- Dental Trauma and Research Detachment, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas.,School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Laura Gaviria
- Department of Biomedical Engineering, University of Texas at San Antonio, Texas
| | - David T Silliman
- Dental Trauma and Research Detachment, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas
| | - John F Decker
- Dental Trauma and Research Detachment, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas
| | - Pamela Brown Baer
- Dental Trauma and Research Detachment, United States Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas.,Clinical Operations and New Product Commercialization, GenCure, San Antonio, Texas
| | - Teja Guda
- Department of Biomedical Engineering, University of Texas at San Antonio, Texas
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Le TD, Gurney JM, Nnamani NS, Gross KR, Chung KK, Stockinger ZT, Nessen SC, Pusateri AE, Akers KS. A 12-Year Analysis of Nonbattle Injury Among US Service Members Deployed to Iraq and Afghanistan. JAMA Surg 2019; 153:800-807. [PMID: 29847675 DOI: 10.1001/jamasurg.2018.1166] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Nonbattle injury (NBI) among deployed US service members increases the burden on medical systems and results in high rates of attrition, affecting the available force. The possible causes and trends of NBI in the Iraq and Afghanistan wars have, to date, not been comprehensively described. Objectives To describe NBI among service members deployed to Iraq and Afghanistan, quantify absolute numbers of NBIs and proportion of NBIs within the Department of Defense Trauma Registry, and document the characteristics of this injury category. Design, Setting, and Participants In this retrospective cohort study, data from the Department of Defense Trauma Registry on 29 958 service members injured in Iraq and Afghanistan from January 1, 2003, through December 31, 2014, were obtained. Injury incidence, patterns, and severity were characterized by battle injury and NBI. Trends in NBI were modeled using time series analysis with autoregressive integrated moving average and the weighted moving average method. Statistical analysis was performed from January 1, 2003, to December 31, 2014. Main Outcomes and Measures Primary outcomes were proportion of NBIs and the changes in NBI over time. Results Among 29 958 casualties (battle injury and NBI) analyzed, 29 003 were in men and 955 were in women; the median age at injury was 24 years (interquartile range, 21-29 years). Nonbattle injury caused 34.1% of total casualties (n = 10 203) and 11.5% of all deaths (206 of 1788). Rates of NBI were higher among women than among men (63.2% [604 of 955] vs 33.1% [9599 of 29 003]; P < .001) and in Operation New Dawn (71.0% [298 of 420]) and Operation Iraqi Freedom (36.3% [6655 of 18 334]) compared with Operation Enduring Freedom (29.0% [3250 of 11 204]) (P < .001). A higher proportion of NBIs occurred in members of the Air Force (66.3% [539 of 810]) and Navy (48.3% [394 of 815]) than in members of the Army (34.7% [7680 of 22 154]) and Marine Corps (25.7% [1584 of 6169]) (P < .001). Leading mechanisms of NBI included falls (2178 [21.3%]), motor vehicle crashes (1921 [18.8%]), machinery or equipment accidents (1283 [12.6%]), blunt objects (1107 [10.8%]), gunshot wounds (728 [7.1%]), and sports (697 [6.8%]), causing predominantly blunt trauma (7080 [69.4%]). The trend in proportion of NBIs did not decrease over time, remaining at approximately 35% (by weighted moving average) after 2006 and approximately 39% by autoregressive integrated moving average. Assuming stable battlefield conditions, the autoregressive integrated moving average model estimated that the proportion of NBIs from 2015 to 2022 would be approximately 41.0% (95% CI, 37.8%-44.3%). Conclusions and Relevance In this study, approximately one-third of injuries during the Iraq and Afghanistan wars resulted from NBI, and the proportion of NBIs was steady for 12 years. Understanding the possible causes of NBI during military operations may be useful to target protective measures and safety interventions, thereby conserving fighting strength on the battlefield.
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Affiliation(s)
- Tuan D Le
- US Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Jennifer M Gurney
- US Army Institute of Surgical Research, Fort Sam Houston, Texas.,Joint Trauma System, Fort Sam Houston, Texas.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Nina S Nnamani
- US Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Kirby R Gross
- Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Army Trauma Training Detachment, Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Kevin K Chung
- Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Zsolt T Stockinger
- Joint Trauma System, Fort Sam Houston, Texas.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shawn C Nessen
- US Army Institute of Surgical Research, Fort Sam Houston, Texas
| | | | - Kevin S Akers
- US Army Institute of Surgical Research, Fort Sam Houston, Texas.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Mitchener TA, Dickens NE, Simecek JW. Causes of Oral–Maxillofacial Injury of U.S. Military Personnel in Iraq and Afghanistan, 2001–2014. Mil Med 2017. [DOI: 10.1093/milmed/usx083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Timothy A Mitchener
- United States Army Institute of Surgical Research, 3650 Chambers Pass, Bldg. 3610, Joint Base San Antonio/Fort Sam Houston, TX 78234
| | - Noel E Dickens
- Naval Medical Research Unit San Antonio, 3650 Chambers Pass, Bldg. 3610, Joint Base San Antonio/Fort Sam Houston, TX 78234
| | - John W Simecek
- Naval Medical Research Unit San Antonio, 3650 Chambers Pass, Bldg. 3610, Joint Base San Antonio/Fort Sam Houston, TX 78234
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Lanigan A, Lindsey B, Maturo S, Brennan J, Laury A. The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan: 2011-2016. Otolaryngol Head Neck Surg 2017; 157:602-607. [DOI: 10.1177/0194599817725713] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Define the number and type of facial and penetrating neck injuries sustained in combat operations in Iraq and Afghanistan from 2011 to 2016. Compare recent injury trends to prior years of modern conflict. Study Design Case series with chart review. Setting Tertiary care hospital. Methods The Joint Theater Trauma Registry (JTTR) was queried for facial and neck injuries from Iraq and Afghanistan from June 2011 to May 2016. Injury patterns, severity, and patient demographics were analyzed and compared to previously published data from combat operations during January 2003 to May 2011. Results A total of 5312 discrete facial and neck injuries among 922 service members were identified. There were 3842 soft tissue injuries (72.3%) of the head/neck and 1469 (27.7%) facial fractures. Soft tissue injuries of the face/cheek (31.4%) and neck/larynx/trachea (18.8%) were most common. The most common facial fractures were of the orbit (26.3%) and maxilla/zygoma (25.1%). Injuries per month were highest in 2011 to 2012 and steadily declined through 2016. The percentage of nonbattle injuries trended up over time, ranging from 14.7% to 65%. Concurrent facial/neck soft tissue trauma or fracture was associated with an overall mortality rate of 2.44%. Comparison of our data to that previously published revealed no statistical difference in concurrent mortality (3.5%-2.2%, P = .053); an increase in orbital fractures ( P < .005), facial nerve injury ( P < .0005), and ear/tympanic membrane perforations ( P < .0005); and a decrease in mandible fractures ( P < .005). Conclusion Penetrating neck and facial injuries remain common in modern warfare. Assessing injury characteristics and trends supports continued improvements in battlefield protection and identifies areas requiring further intervention.
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Affiliation(s)
- Alexander Lanigan
- Department of Otolaryngology–Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Brentley Lindsey
- Uniformed Services University, F. Edward Hebert School of Medicine, Bethesda, Maryland, USA
| | - Stephen Maturo
- Department of Otolaryngology–Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Joseph Brennan
- Department of Otolaryngology–Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Adrienne Laury
- Department of Otolaryngology–Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
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Combat-Related Facial Burns: Analysis of Strategic Pitfalls. J Oral Maxillofac Surg 2015; 73:106-11. [DOI: 10.1016/j.joms.2014.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 07/28/2014] [Accepted: 08/14/2014] [Indexed: 11/22/2022]
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Guda T, Labella C, Chan R, Hale R. Quality of bone healing: Perspectives and assessment techniques. Wound Repair Regen 2014; 22 Suppl 1:39-49. [DOI: 10.1111/wrr.12167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 01/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Teja Guda
- Dental Trauma Research Detachment; US Army Institute of Surgical Research; Fort Sam Houston
- Wake Forest Institute for Regenerative Medicine; Winston-Salem North Carolina
- Biomedical Engineering; University of Texas at San Antonio; San Antonio Texas
| | - Carl Labella
- Dental Trauma Research Detachment; US Army Institute of Surgical Research; Fort Sam Houston
| | - Rodney Chan
- Dental Trauma Research Detachment; US Army Institute of Surgical Research; Fort Sam Houston
| | - Robert Hale
- Dental Trauma Research Detachment; US Army Institute of Surgical Research; Fort Sam Houston
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