Dismounted blast injuries in patients treated at a role 3 military hospital in Afghanistan: Patterns of injury and mortality

John S. Oh, Creighton C. Tubb, Thomas P. Poepping, Paul Ryan, Jonathan C. Clasper, Adrian R. Katschke, Caroline Tuman, Michael J. Murray

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: The purposes of this study are to define the pattern of injuries sustained by dismounted troops exposed to improvised explosive devices blasts treated at a Role 3 combat support hospital and to assess injury patterns and mortality associated with the mechanism. Our hypothesis was that mortality is associated with pelvic fracture, massive transfusion, high Injury Severity Score (ISS), multiple limb amputations, and transfer from a Role 2 facility. Study Design: Retrospective study of 457 patients. Analysis performed on trauma registry data and systematic review of radiographs. Results: 99.9% were men with a median age of 23 years and median ISS 10. 141 patients (30.9%) required massive blood transfusion. Limb amputations were frequently observed injuries, 109 of 172 amputees (63.4%) had a double amputation. 34 subjects (7.4%) had pelvic fractures; majority of pelvic fractures (88%) were unstable (Tile B or C). Risk factors associated with the overall mortality rate of 1.8% were an ISS greater than 15 (odds ratio: 11.5; 95% confidence interval: 1.38, 533; p = 0.009), need for massive transfusion (p < 0.0001), and the presence of a pelvic fracture (odds ratio: 7.63; 95% confidence interval: 1.13, 41.3; p = 0.018). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1069-1074
Number of pages6
JournalMilitary medicine
Volume181
Issue number9
DOIs
StatePublished - Sep 2016

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Blast Injuries
Afghanistan
Military Hospitals
Amputation
Injury Severity Score
Mortality
Wounds and Injuries
Extremities
Odds Ratio
Confidence Intervals
Amputees
Equipment and Supplies
Resuscitation
Blood Transfusion
Registries
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

Oh, John S. ; Tubb, Creighton C. ; Poepping, Thomas P. ; Ryan, Paul ; Clasper, Jonathan C. ; Katschke, Adrian R. ; Tuman, Caroline ; Murray, Michael J. / Dismounted blast injuries in patients treated at a role 3 military hospital in Afghanistan : Patterns of injury and mortality. In: Military medicine. 2016 ; Vol. 181, No. 9. pp. 1069-1074.
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abstract = "Background: The purposes of this study are to define the pattern of injuries sustained by dismounted troops exposed to improvised explosive devices blasts treated at a Role 3 combat support hospital and to assess injury patterns and mortality associated with the mechanism. Our hypothesis was that mortality is associated with pelvic fracture, massive transfusion, high Injury Severity Score (ISS), multiple limb amputations, and transfer from a Role 2 facility. Study Design: Retrospective study of 457 patients. Analysis performed on trauma registry data and systematic review of radiographs. Results: 99.9{\%} were men with a median age of 23 years and median ISS 10. 141 patients (30.9{\%}) required massive blood transfusion. Limb amputations were frequently observed injuries, 109 of 172 amputees (63.4{\%}) had a double amputation. 34 subjects (7.4{\%}) had pelvic fractures; majority of pelvic fractures (88{\%}) were unstable (Tile B or C). Risk factors associated with the overall mortality rate of 1.8{\%} were an ISS greater than 15 (odds ratio: 11.5; 95{\%} confidence interval: 1.38, 533; p = 0.009), need for massive transfusion (p < 0.0001), and the presence of a pelvic fracture (odds ratio: 7.63; 95{\%} confidence interval: 1.13, 41.3; p = 0.018). Conclusions: 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.",
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Oh, JS, Tubb, CC, Poepping, TP, Ryan, P, Clasper, JC, Katschke, AR, Tuman, C & Murray, MJ 2016, 'Dismounted blast injuries in patients treated at a role 3 military hospital in Afghanistan: Patterns of injury and mortality', Military medicine, vol. 181, no. 9, pp. 1069-1074. https://doi.org/10.7205/MILMED-D-15-00264

Dismounted blast injuries in patients treated at a role 3 military hospital in Afghanistan : Patterns of injury and mortality. / Oh, John S.; Tubb, Creighton C.; Poepping, Thomas P.; Ryan, Paul; Clasper, Jonathan C.; Katschke, Adrian R.; Tuman, Caroline; Murray, Michael J.

In: Military medicine, Vol. 181, No. 9, 09.2016, p. 1069-1074.

Research output: Contribution to journalArticle

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T1 - Dismounted blast injuries in patients treated at a role 3 military hospital in Afghanistan

T2 - Patterns of injury and mortality

AU - Oh, John S.

AU - Tubb, Creighton C.

AU - Poepping, Thomas P.

AU - Ryan, Paul

AU - Clasper, Jonathan C.

AU - Katschke, Adrian R.

AU - Tuman, Caroline

AU - Murray, Michael J.

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N2 - Background: The purposes of this study are to define the pattern of injuries sustained by dismounted troops exposed to improvised explosive devices blasts treated at a Role 3 combat support hospital and to assess injury patterns and mortality associated with the mechanism. Our hypothesis was that mortality is associated with pelvic fracture, massive transfusion, high Injury Severity Score (ISS), multiple limb amputations, and transfer from a Role 2 facility. Study Design: Retrospective study of 457 patients. Analysis performed on trauma registry data and systematic review of radiographs. Results: 99.9% were men with a median age of 23 years and median ISS 10. 141 patients (30.9%) required massive blood transfusion. Limb amputations were frequently observed injuries, 109 of 172 amputees (63.4%) had a double amputation. 34 subjects (7.4%) had pelvic fractures; majority of pelvic fractures (88%) were unstable (Tile B or C). Risk factors associated with the overall mortality rate of 1.8% were an ISS greater than 15 (odds ratio: 11.5; 95% confidence interval: 1.38, 533; p = 0.009), need for massive transfusion (p < 0.0001), and the presence of a pelvic fracture (odds ratio: 7.63; 95% confidence interval: 1.13, 41.3; p = 0.018). Conclusions: 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.

AB - Background: The purposes of this study are to define the pattern of injuries sustained by dismounted troops exposed to improvised explosive devices blasts treated at a Role 3 combat support hospital and to assess injury patterns and mortality associated with the mechanism. Our hypothesis was that mortality is associated with pelvic fracture, massive transfusion, high Injury Severity Score (ISS), multiple limb amputations, and transfer from a Role 2 facility. Study Design: Retrospective study of 457 patients. Analysis performed on trauma registry data and systematic review of radiographs. Results: 99.9% were men with a median age of 23 years and median ISS 10. 141 patients (30.9%) required massive blood transfusion. Limb amputations were frequently observed injuries, 109 of 172 amputees (63.4%) had a double amputation. 34 subjects (7.4%) had pelvic fractures; majority of pelvic fractures (88%) were unstable (Tile B or C). Risk factors associated with the overall mortality rate of 1.8% were an ISS greater than 15 (odds ratio: 11.5; 95% confidence interval: 1.38, 533; p = 0.009), need for massive transfusion (p < 0.0001), and the presence of a pelvic fracture (odds ratio: 7.63; 95% confidence interval: 1.13, 41.3; p = 0.018). Conclusions: 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.

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