Died of wounds on the battlefield: Causation and implications for improving combat casualty care

Brian J Eastridge, Mark Hardin, Joyce Cantrell, Lynne Oetjen-Gerdes, Tamara Zubko, Craig Mallak, Charles E. Wade, John Simmons, James MacE, Robert Mabry, Rose Bolenbaucher, Lorne H. Blackbourne

Research output: Contribution to journalArticle

249 Citations (Scopus)

Abstract

Background: Understanding the epidemiology of death after battlefield injury is vital to combat casualty care performance improvement. The current analysis was undertaken to develop a comprehensive perspective of deaths that occurred after casualties reached a medical treatment facility. Methods: Battle injury died of wounds (DOW) deaths that occurred after casualties reached a medical treatment facility from October 2001 to June 2009 were evaluated by reviewing autopsy and other postmortem records at the Office of the Armed Forces Medical Examiners (OAFME). A panel of military trauma experts classified the injuries as nonsurvivable (NS) or potentially survivable (PS), in consultation with an OAFME forensic pathologist. Data including demographics, mechanism of injury, physiologic and laboratory variables, and cause of death were obtained from the Joint Theater Trauma Registry and the OAFME Mortality Trauma Registry. Results: DOW casualties (n = 558) accounted for 4.56% of the nonreturn to duty battle injuries over the study period. DOW casualties were classified as NS in 271 (48.6%) cases and PS in 287 (51.4%) cases. Traumatic brain injury was the predominant injury leading to death in 225 of 271 (83%) NS cases, whereas hemorrhage from major trauma was the predominant mechanism of death in 230 of 287 (80%) PS cases. In the hemorrhage mechanism PS cases, the major body region bleeding focus accounting for mortality were torso (48%), extremity (31%), and junctional (neck, axilla, and groin) (21%). Fifty-one percent of DOW casualties presented in extremis with cardiopulmonary resuscitation upon presentation. Conclusions: Hemorrhage is a major mechanism of death in PS combat injuries, underscoring the necessity for initiatives to mitigate bleeding, particularly in the prehospital environment.

Original languageEnglish (US)
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue numberSUPPL. 1
DOIs
StatePublished - Jul 2011
Externally publishedYes

Fingerprint

Causality
Wounds and Injuries
Coroners and Medical Examiners
Hemorrhage
Registries
Torso
Body Regions
Axilla
Mortality
Groin
Cardiopulmonary Resuscitation
Cause of Death
Autopsy
Epidemiology
Neck
Referral and Consultation
Extremities
Joints
Demography

Keywords

  • Combat
  • Died of wounds
  • Injury
  • Military
  • Survivability
  • Trauma
  • War

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Eastridge, B. J., Hardin, M., Cantrell, J., Oetjen-Gerdes, L., Zubko, T., Mallak, C., ... Blackbourne, L. H. (2011). Died of wounds on the battlefield: Causation and implications for improving combat casualty care. Journal of Trauma - Injury, Infection and Critical Care, 71(SUPPL. 1). https://doi.org/10.1097/TA.0b013e318221147b

Died of wounds on the battlefield : Causation and implications for improving combat casualty care. / Eastridge, Brian J; Hardin, Mark; Cantrell, Joyce; Oetjen-Gerdes, Lynne; Zubko, Tamara; Mallak, Craig; Wade, Charles E.; Simmons, John; MacE, James; Mabry, Robert; Bolenbaucher, Rose; Blackbourne, Lorne H.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 71, No. SUPPL. 1, 07.2011.

Research output: Contribution to journalArticle

Eastridge, BJ, Hardin, M, Cantrell, J, Oetjen-Gerdes, L, Zubko, T, Mallak, C, Wade, CE, Simmons, J, MacE, J, Mabry, R, Bolenbaucher, R & Blackbourne, LH 2011, 'Died of wounds on the battlefield: Causation and implications for improving combat casualty care', Journal of Trauma - Injury, Infection and Critical Care, vol. 71, no. SUPPL. 1. https://doi.org/10.1097/TA.0b013e318221147b
Eastridge, Brian J ; Hardin, Mark ; Cantrell, Joyce ; Oetjen-Gerdes, Lynne ; Zubko, Tamara ; Mallak, Craig ; Wade, Charles E. ; Simmons, John ; MacE, James ; Mabry, Robert ; Bolenbaucher, Rose ; Blackbourne, Lorne H. / Died of wounds on the battlefield : Causation and implications for improving combat casualty care. In: Journal of Trauma - Injury, Infection and Critical Care. 2011 ; Vol. 71, No. SUPPL. 1.
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abstract = "Background: Understanding the epidemiology of death after battlefield injury is vital to combat casualty care performance improvement. The current analysis was undertaken to develop a comprehensive perspective of deaths that occurred after casualties reached a medical treatment facility. Methods: Battle injury died of wounds (DOW) deaths that occurred after casualties reached a medical treatment facility from October 2001 to June 2009 were evaluated by reviewing autopsy and other postmortem records at the Office of the Armed Forces Medical Examiners (OAFME). A panel of military trauma experts classified the injuries as nonsurvivable (NS) or potentially survivable (PS), in consultation with an OAFME forensic pathologist. Data including demographics, mechanism of injury, physiologic and laboratory variables, and cause of death were obtained from the Joint Theater Trauma Registry and the OAFME Mortality Trauma Registry. Results: DOW casualties (n = 558) accounted for 4.56{\%} of the nonreturn to duty battle injuries over the study period. DOW casualties were classified as NS in 271 (48.6{\%}) cases and PS in 287 (51.4{\%}) cases. Traumatic brain injury was the predominant injury leading to death in 225 of 271 (83{\%}) NS cases, whereas hemorrhage from major trauma was the predominant mechanism of death in 230 of 287 (80{\%}) PS cases. In the hemorrhage mechanism PS cases, the major body region bleeding focus accounting for mortality were torso (48{\%}), extremity (31{\%}), and junctional (neck, axilla, and groin) (21{\%}). Fifty-one percent of DOW casualties presented in extremis with cardiopulmonary resuscitation upon presentation. Conclusions: Hemorrhage is a major mechanism of death in PS combat injuries, underscoring the necessity for initiatives to mitigate bleeding, particularly in the prehospital environment.",
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AU - Wade, Charles E.

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