Bone and Soft Tissue Trauma Research at the USAISR1

Since its establishment in 1943, the United States Army Institute of Surgical Research (USAISR) has conducted research focused on improving the surgical care given to soldiers. Just as our predecessors addressed the unacceptably high impact of thermal injury on combat casualties, the Bone and Soft Tissue Research Team focuses research on combat casualties by examining the epidemiology of combat wounds to identify needed improvements in combat casualty care. This paper provides an overview of the bone and soft tissue trauma research currently being conducted at the USAISR and introduces the available combat casualty data from recent conflicts that were used to identify areas where research can achieve maximum impact on reducing the morbidity and mortality rates of combat casualties. 1.0 COMBAT CASUALTY STATISTICS Because the Vietnam War ended over a quarter century ago, we sought data from more recent conflicts on which to base our research efforts. While we have been fortunate to have suffered relatively few combat casualties at the end of the 20th century, Operation Just Cause (Panama), Operation Desert Storm (Kuwait and Iraq) and the Battle of the Black Sea (Somalia) offered the opportunity to investigate more recent patterns of combat injury. Fortunately, the patterns of injury were documented both during and after each of these conflicts, as had been done in Vietnam by the Wound Data and Munitions Effectiveness Team (WEDMET). Despite the great disparity in missions, environments, enemy, weaponry, and the units engaged, the distribution of wounds was surprisingly consistent in these three conflicts (Table 1 and Figure 1). In each conflict, extremity wounds predominated, constituting between 70% to 75% of all wounds. Another interesting finding from the data collected following Operation Just Cause is the preponderance of minor to moderate wounds in combat casualties as indicated by injury severity scores (Figure 2), a finding consistent with a similar analysis of casualties from Vietnam. With this new appreciation of the importance of extremity wounds in general, and wounds of mild to moderate severity in particular, we set out to identify medical interventions which target these types of wounds. 1 The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Paper presented at the RTO HFM Symposium on “Combat Casualty Care in Ground Based Tactical Situations: Trauma Technology and Emergency Medical Procedures”, held in St. Pete Beach, USA, 16-18 August 2004, and published in RTO-MP-HFM-109. Bone and Soft Tissue Trauma Research at the USAISR P35 2 RTO-MP-HFM-109 Table 1: Anatomical distribution of injury as a percentage of total number of wounds in observed in soldiers wounded in action during Operation Just Cause (OJC), Operation Desert Storm (ODS) and the Battle of the Black Sea (Somalia). Injury Location OJC ODS Somalia Weighted Average Extremity 70% 71% 75% 71% Thorax 9% 4% 7% 6% Head/Neck 9% 15% 14% 13% Pelvis 4% 2% 1% 3% Abdomen 4% 4% 3% 4% Eye 2% 2% 0% 2% Spine 1% 1% 0% 1% 0% 10% 20% 30% 40% 50% 60% 70% 80% Extremity Head/Neck Thorax Pelvis Abdomen Eye Spine Injury Location OJC ODS Somalia Figure 1: Anatomical distribution of wounds which were recorded for WIA in Operation Just Cause, Operation Desert Storm, and the Somalia. Data were compiled from McBride, et al [3] (Operation Just Cause), Uhorchak et al. [4] (Operation Desert Storm) and Mabry, et al. [5] (Somalia). The patterns of anatomical distribution of injury are highly consistent, and highlight that extremity wounds cause a greater number of casualties than all other wounds combined. Bone and Soft Tissue Trauma Research at the USAISR RTO-MP-HFM-109 P35 3 Injury Severity Scores Operation Just Cause Injury Severity Score 0 to 5 6 to 10 11 to 15 16 to 20 21 to 25 >25 Pe rc en t o f C as ua lti es