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Incidence of primary blast injury increased over 4 years
Ritenour AE. Ann Surg. doi:10.1097/SLA.0b013e3181e01270.
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The incidence of primary blast injury and injury severity among U.S. military service members increased during a 4-year period while return-to-duty rates dropped, according to results of this retrospective study.
“Despite increasingly devastating injuries, the mortality rate due to explosion injuries remained low and unchanged,” Amber E. Ritenour, MD, U.S. Army Institute of Surgical Research and colleagues wrote in their study.
The researchers used the Joint Theater Trauma Registry to gather demographic information, Injury Severity Score (ISS) and International Classification of Diseases 9 codes on service members injured in explosions between March 2003 and October 2006. They also reviewed the autopsy reports of the last 497 combat-related deaths of 2006.
During the 4-year study period, 9,693 service members were admitted to the hospital, of which 6,687 were injured in combat. In total, 4,765 service members sustained explosion injuries: 2,588 in 2003 to 2004 and 1,935 in 2005 to 2006. Injury dates were unavailable for 242 patients.
Ritenour and colleagues noted increases in the ISS (9 +/- 10 vs. 11 +/- 10, P<.0001) and the incidence of primary blast injury from 12% to 15% (P<.01). In addition, although the return-to-duty rate decreased from 40% to 18% (P<.001), mortality remained low, increasing from 1.4% to 1.5%. The researchers found no significant difference in incidence of primary blast injury between personnel killed in action and those who died of wounds at a medical facility.
This retrospective study using data from the Joint Theater Trauma Registry (JTTR) quantifies what has been known about combat injuries from the current conflicts. Most combat casualties are caused from explosive ordnance, and this ordnance, primarily improvised explosive devices have become more sophisticated — and deadly — over time. The weakness of the study is that it is retrospective and not all the data in the JTTR is accurate. Also, the term “blast injury” refers to an injury caused by the blast wave to the lungs, ears, viscous organs, etc. Did they also include patients with secondary blast injuries — those injured by fragments?
This study quantifies blast injuries from the current conflicts.
–Capt. D. C. Covey, MC, USN
Chairman, Department of Orthopedic Surgery,
Naval Medical Center, San Diego, Calif.