Citation

Breeze J, Bowley DMG, Combes JG, Baden J, Orr L, Beggs A, Dubose J, Powers DB. J. Trauma Acute Care Surg. 2020; ePub(ePub): ePub.

Affiliation

Duke University Medical Center, Durham, North Carolina, US. David.Powers@duke.edu.

Copyright

(Copyright © 2020, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002625

PMID

32068717

Abstract

INTRODUCTION: The United States (US) and United Kingdom (UK) had differing approaches to the surgical skill mix within deployed Medical Treatment Facilities (MTF) in support of the military campaigns in Iraq and Afghanistan.

METHODS: The US and UK combat trauma registries were scrutinized for patients with penetrating neck injury (PNI) at deployed coalition MTF between March 2003 and October 2011. A multivariate mixed effects logistic regression model (threshold p< 0.05) was used stratified by MTF location and year of injury. The dependent variable was fatality on leaving Role 3, and independent variables ISS on arrival, nationality, MTF nationality, and presence of head and neck surgeon.

RESULTS: 3357/67586 (4.9%) of patients who arrived alive at deployed military MTF were recorded to have sustained neck injuries; of which 2186 (83%) were PNI and the remainder were blunt injuries. When service members KIA were included, the incidence of neck injury rose from 4.9 to 10%. 709/2186 (32%) patients with PNI underwent neck exploration; 555 patients were recorded to have sustained cervical vascular injury, 230/555 (41%) underwent vascular ligation or repair. Where it was recorded, PNI directly contributed to death in 64/228 (28%) of patients. Fatality status was positively associated with ISS on arrival (OR 1.05, 95% CI 1.04 -1.06, p<0.001) and the casualty being a local national (OR 1.74, 95% CI: 1.28-2.38, p<0.001).

CONCLUSIONS: Significant differences in the treatment and survival of casualties with PNI were identified between nations in this study, this may reflect differing cervical protection, management protocols and surgical capability and is worthy of further study. In an era of increasing specialization within surgery, neck exploration remains a skill that must be retained by military surgeons deploying to Role 2 and Role 3 MTF. LEVEL OF EVIDENCE: Level 3: retrospective study with up to two negative criteria.

Language: en