The UK military experience of thoracic injury in the wars in Iraq and Afghanistan

Poon, Henrietta; Morrison, Jonathan J.; Apodaca, Amy; Khan, Mansoor A.; Garner, Jeff

doi:10.1016/j.injury.2013.01.041

Cited by 23 publications

(24 citation statements)

References 30 publications

(28 reference statements)

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“…Dix thoracotomies de ressuscitation ont été réalisées en métropole et en OPEX chez des patients en ACR ou en instabilité extrême à l'admission. L'arrêt cardiaque chez les patients traumatisés thoraciques a été retrouvé comme facteur de mortalité indépendant (57).…”

Section: V-2-2/ Des Indications Larges De La Thoracotomie De Ressusciunclassified

“…Si la protection individuelle du combattant a permis de limiter les zones exposées, le thorax est une zone lésée dans un tiers des cas et est liée à la mortalité dans 14 à 24% des cas (21,57,122,123). La mortalité des patients victimes de traumatismes thoraciques est 3 fois plus importante que chez ceux qui n'en présentent pas (57).…”

Section: V-4-1/ Le Ttp Comme Lésion Létale Par La Présence De Structuunclassified

“…La présence de traumatismes crâniens ou abdominaux associés est un facteur indépendant de mortalité (57). Enfin, la présence d'un traumatisme thoraco-abdominal multiplie jusqu'à presque 5 fois le risque de mortalité par rapport à un traumatisme thoracique isolé (131).…”

Section: V-4-5/ Les Lésions Associées Sont Fréquentes Et Menacent Le unclassified

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Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre

et al. 2019

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BackgroundPenetrating thoracic injuries (PTIs) is a medicosurgical challenge for civilian and military trauma teams. In civilian European practice, PTIs are most likely due to stab wounds and mostly require a simple chest tube drainage. On the battlefield, combat casualties suffer severe injuries, caused by high-lethality wounding agents.The aim of this study was to analyse and compare the demographics, injury patterns, surgical management and clinical outcomes of civilian and military patients with PTIs.MethodsAll patients with PTIs admitted to a Level I Trauma Centre in France or to Role-2 facilities in war theatres between 1 January 2004 and 31 May 2016 were included. Combat casualties’ data were analysed from Role-2 medical charts. The hospital manages military casualties evacuated from war theatres who had already received primary surgical care, but also civilian patients issued from the Paris area. During the study period, French soldiers were deployed in Afghanistan, in West Africa and in the Sahelo-Saharan band since 2013.Results52 civilian and 17 military patients were included. Main mechanisms of injury were stab wounds for civilian patients, and gunshot wounds and explosive fragments for military casualties. Military patients suffered more severe injuries and needed more thoracotomies. In total, 29 (33%) patients were unstable or in cardiac arrest on admission. Thoracic surgery was performed in 38 (55%) patients (25 thoracotomies and 13 thoracoscopies). Intrahospital mortality was 18.8%.ConclusionWar PTIs are associated with extrathoracic injuries and higher mortality than PTIs in the French civilian area. In order to reduce the mortality of PTIs in combat, our study highlights the need to improve tactical en route care with transfusion capabilities and the deployment of forward surgical units closer to the combatants. In the civilian area, our results indicated that video-assisted thoracoscopic surgery is a reliable diagnostic and therapeutic technique for haemodynamically stable patients.

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Section: V-2-2/ Des Indications Larges De La Thoracotomie De Ressusciunclassified

Section: V-4-1/ Le Ttp Comme Lésion Létale Par La Présence De Structuunclassified

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Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre

et al. 2019

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“…While penetrating injuries to the thorax can be highly lethal, for patients who reach the hospital alive, mortality in recent military and civilian series has ranged from 8.4 to 18.0 % [1][2][3][4]. Overall, injuries to the thorax account for 37 % of deaths associated with penetrating trauma [5].…”

Section: Introductionmentioning

confidence: 99%

Penetrating Injuries to the Lung and Heart: Resuscitation, Diagnosis, and Operative Indications

Scott

Sava

2015

Curr Trauma Rep

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Penetrating injuries to the thorax have the potential to disrupt two vital life-sustaining systems: the respiratory and the cardiovascular system. These injuries have the potential to be rapidly fatal and thus a rapid, organized, and logical approach to the evaluation and resuscitation of these patients is critical. This article briefly reviews the basic pathophysiology of penetrating chest wounds and the evaluation of both stable and unstable patients after penetrating chest injury. The recent literature is reviewed, including recent findings on screening for occult penetrating cardiac injuries, the use of needle decompression for pneumothoraces, and the expanding role of ultrasonography in the evaluation of penetrating thoracic trauma. Our goal is to review the initial management and resuscitation of patients with penetrating wounds to the thorax, with an eye toward the injuries most likely to rapidly result in death.

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“…These blast injuries not only caused economic damage but also seriously affected people's life. In Western countries, terrorist attacks (such as these in Paris in 2015 and Sri Lanka in 2019) and local con icts (such as the wars in Afghanistan and Iraq) have also caused one out of 10 military casualties and 6-9 out of 10 civilian victims suffered blast injuries [4][5][6].…”

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confidence: 99%

Quantitative proteomic analysis and identification of differentially expressed proteins involved in blast exposure-induced inflammatory response

Liu¹,

Tong

Cong

et al. 2020

Preprint

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Abstract Background Previous studies found that blast injury caused a significant increased expression of interleukin-1, IL-6 and tumor necrosis factor, a significant decrease in the expression of IL-10, an increase in Evans blue leakage, and a significant increase in inflammatory cell infiltration in the lungs. However, the molecular characteristics of lung injury at different time points after blast exposure have not yet been reported. Therefore, in this study, tandem mass spectrometry (TMT) quantitative proteomics and bioinformatics analysis were used for the first time to gain a deeper understanding of the molecular mechanism of lung blast injury at different time points. Methods Fourty-eight male C57BL/6 mice were randomly divided into six groups: control, 12 h, 24 h, 48 h, 72 h and 1 w after low-intensity blast exposure. TMT quantitative proteomics and bioinformatics analysis were performed to analyze protein expression profiling in the lungs from control and blast-exposed mice, and differential protein expression was verified by Western blotting. Results The results demonstrated that blast exposure induced severe lung injury, leukocyte infiltration, and the production of inflammatory factors in mice. After analyzing the expression changes in global proteins and inflammation-related proteomes after blast exposure, the results showed that a total of 6,861 global proteins and 608 differentially expressed proteins were identified, of which 215, 128, 187, 232, and 65 proteins were identified at 12 h, 24 h, 48 h, 72 h, and 1 week after blast exposure, respectively. Moreover, blast exposure-induced 177 differentially expressed proteins were associated with inflammatory responses, which were enriched in the inflammatory response regulation, leukocyte transendothelial migration, phagocytosis, and immune response. Conclusions Therefore, blast exposure may induce early inflammatory response of lung tissue by regulating the expression of key proteins in the inflammatory process, suggesting that early inflammatory response may be the initiating factor of lung blast injury. These data can provide potential therapeutic candidates or approaches for the development of future treatment of lung blast injury.

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The UK military experience of thoracic injury in the wars in Iraq and Afghanistan

Cited by 23 publications

References 30 publications

Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre

Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre

Penetrating Injuries to the Lung and Heart: Resuscitation, Diagnosis, and Operative Indications

Quantitative proteomic analysis and identification of differentially expressed proteins involved in blast exposure-induced inflammatory response

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