Type and severity of combat wounds in Iraq war have changed over time

The transition in Iraq from maneuver warfare to insurgency warfare is associated with changes in the type and severity of injuries treated by surgical units of the U.S. Marine Corps, according to a report in the June issue of Archives of Surgery, one of the JAMA/Archives journals. In the second, insurgent phase of the war, injuries have been more severe, transport times longer, more injuries have occurred per individual and more soldiers have been killed in action or died of their wounds.

"Operation Iraqi Freedom is an ongoing conflict that has changed dramatically since the initial invasion," the authors write as background information in the article. "Following the maneuver warfare that resulted in the capture of Baghdad, Iraq, in April 2003, firm U.S. military bases have been established throughout the country to support the Iraqi government and to fight insurgencies."

During the first phase of warfare (March and April 2003), the Forward Resuscitative Surgery System—a small mobile surgery team of eight personnel that treated soldiers' injuries —moved 11 times as the battlefield changed. In the second phase of the war, from March 2004 to February 2005, medical support for U.S. forces has remained stationary.

Stacy A. Brethauer, M.D., of Cleveland Clinic, and colleagues analyzed records from combat trauma databases for 338 casualties treated during the first phase of the war (maneuver) and 895 treated in the second phase (insurgency). When comparing those injured in phase II with those injured in phase I, the authors found that:

-- More major injuries occurred per patient (2.4 vs. 1.6)
-- More individuals sustained fragment wounds (61 percent vs. 48 percent) but fewer were injured by gunshots (33 percent vs. 43 percent)
-- Critically injured U.S. casualties took longer to reach the surgical unit (a median or midpoint time of 59 minutes vs. 30 minutes)
-- The percentage of individuals killed in action before reaching the surgical unit increased (20.2 percent from 13.5 percent)
-- The percentage of patients who died of their wounds after evaluation by a physician also increased, from 0.88 percent to 5.5 percent

In the second phase of the war, the use of improvised explosive devices by insurgents has resulted in more fragment wounds and a higher percentage of critically injured patients arriving to the surgical unit. "A higher percentage of patients arriving at the Forward Resuscitative Surgery System are undergoing surgery, and these patients have more injuries and undergo more procedures than casualties during Operation Iraqi Freedom I," the authors write. The higher percentage of surgeries is due to an increase in the number of wounds per patient, the severity of these wounds and the stationary nature of the surgical unit, they note.

Source: JAMA and Archives Journals

Related stories:

'Second skin' helps care for all
CSIRO scientists are creating a ‘second skin’ made from wool and Lycra to help protect the body against wounds and major traumas.
Mental agility plays key role in avoiding falls, study finds
An agile mind may be as important as strong limbs when it comes to the crucial task of preventing falls.
Joyful music may promote heart health
Listening to your favorite music may be good for your cardiovascular system. Researchers at the University of Maryland School of Medicine in Baltimore have shown for the first time that the emotions aroused by joyful music have a healthy effect on blood vessel function.
New hope for stroke patients
If a stroke patient doesn't get treatment within approximately the first three hours of symptoms, there's not much doctors can do to limit damage to the brain.
Teens underestimate risk, overestimate vehicle, highway safety in motor vehicle accidents
Most teens' attitudes regarding trauma-related injuries, particularly those due to motor vehicle crashes, reflect an sense of invincibility and focus on fate rather than choice, according to new research published in the August issue of the Journal of the American College of Surgeons.
Virtual reality and computer technology improve stroke rehabilitation
Israeli hospitals have recently started to use virtual reality therapy for stroke patients. One commonly used program has the patient watch his virtual image on a screen. For example, tennis balls are virtually thrown at the patient from all directions and the patients' actual hand motions are recorded on screen.
Researcher transplants stem cells to try to save patients' legs
A Northwestern University Feinberg School of Medicine researcher has launched the first U.S. trial in which a purified form of subjects' own adult stem cells was transplanted into their leg muscles with severely blocked arteries to try to grow new small blood vessels and restore circulation in their legs.
Researchers find new way to block destructive rush of immune cells
Researchers have found a way to selectively block the ability of white blood cells to “crawl” toward the sites of injury and infection when such mobility drives disease, according to a study published today in The Journal of Experimental Medicine. The results suggest a new treatment approach for autoimmune diseases like rheumatoid arthritis, lupus and multiple sclerosis, and for conditions made worse by misplaced inflammation, like atherosclerosis, stroke and transplant rejection, researchers said.

News discussion:

Medicine & Health news