Dismounted Blast Injuries in Patients Treated at a Role 3 Military Hospital in Afghanistan: Patterns of Injury and Mortality

Abstract

Dismounted improvised explosive devices blast injuries result in devastating multiple limb amputations and unstable pelvic fractures, which are associated with mortality after initial trauma resuscitation at a Role 3 hospital.

An analysis of casualties presenting to military emergency departments in Iraq and Afghanistan

“…Previous studies also found explosives were the most prevalent mechanism of injury with rates of 44.1%-87.9% [3,5,7,[22][23][24]26,27,29,30,[35][36][37][38][39]. Despite a significant proportion of our subjects suffering explosive or GSW injuries, overall mortality was 4.5% which is consistent with previously published mortality rates of 1.8%-6.9% [7,22,23,40,41]. Our observed mortality rate-similar to the cited studies-does not include prehospital fatalities.…”

Incidence of Pelvic Ring Fractures in the U.S. Military Population

“…These results correspond with our hypothesis and could be attributed to younger service members being more likely to be combat service members (i.e. dismounted warfighters) that are exposed to ground-emplaced IEDs [15]. In a study about dismounted blast injuries, the median age of service members was 23 years [15].…”

“…In another U.S. study, researchers reported incidence rates of open versus closed pelvic fractures to be between 7.6% and 92.4% when analyzing 24,059 patients with unstable pelvic ring fractures, respectively, using ICD-9 Clinical Modification Codes [14]. In respect to military trauma, a U.K. Military study reported an overall incidence rate of 7.4% among dismounted soldiers admitted to a field hospital due to blast injuries sustained from IED explosions [15]. Another study using U.K. Military Joint Theatre Trauma Registry reported a total incidence of pelvic ring fractures (both open and closed) to be 0.83 per 1,000 person-years [16].…”

Characteristics of traumatic brain injury during Operation Enduring Freedom–Afghanistan: a retrospective case series

“…4,13,19 In the most recent wars in Afghanistan and Iraq, survivability has improved so much that despite a 64% chance of double amputation following blast injury, mortality remains as low as 1.8%. 23 However, this improvement in survivability has resulted in the greatest incidence of survivable TBI during the ongoing wars in Afghanistan and Iraq (https://dvbic.dcoe.mil/system/files/ tbi-numbers/worldwide-totals-2000-2018Q1-total_jun-21-2018_v1.0_2018-07-26_0.pdf). 8,17,22,24,33 In the current series, 41% of patients had comorbid injuries in addition to head injury requiring neurosurgical intervention, yet only 3 patients died.…”