The epidemiology of noncompressible torso hemorrhage in the wars in Iraq and Afghanistan

Adam Stannard, Jonathan J. Morrison, Daniel J. Scott, Rebecca A. Ivatury, James Ross, Todd E. Rasmussen

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: Noncompressible torso hemorrhage (NCTH) is the leading cause of potentially survivable trauma in the battlefield and has recently been defined using anatomic and physiologic criteria. The objective of this study was to characterize the frequency and mortality in combat of NCTH using a contemporary definition. Methods: Four categories of torso injury, each based on vascular disruption, were identified in US military casualties from the Department of Defense Trauma Registry (2002-2010): (1) thoracic, including lung; (2) solid organ (high-grade spleen, liver, and kidney); (3) named axial vessel; and (4) pelvic fracture with ring disruption. Injuries within these categories were evaluated in the context of physiologic indicator of shock and/or the need for operative hemorrhage control. Results: Of 15,209 battle injuries sustained during the study period, 12.7% (n = 1,936) had sustained one or more categories of torso injury. Of these, 331 (17.1%) had evidence of shock or the need for urgent hemorrhage control, with a mean (SD) Injury Severity Score (ISS) and mortality rate of 30 (13) and 18.7%, respectively. Pulmonary injuries were most numerous (41.7%), followed by solid-organ (29.3%), vascular (25.7%), and pelvic (15.1%) injuries. Following multivariate analysis, the most mortal injury complexes were identified as major arterial injury (odds ratio, 3.38; 95% confidence interval, 1.17-9.74) and pulmonary injury (odds ratio, 2.23; 95% confidence interval, 1.23-4.98). Conclusion: NCTH can be defined using anatomic parameters combined with physiologic and operative interventions suggestive of hemorrhage. Major arterial and pulmonary injuries contribute most significantly to the mortality burden.

Original languageEnglish (US)
Pages (from-to)830-834
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number3
DOIs
StatePublished - Mar 2013
Externally publishedYes

Fingerprint

Afghanistan
Torso
Iraq
Epidemiology
Hemorrhage
Wounds and Injuries
Lung Injury
Blood Vessels
Mortality
Shock
Odds Ratio
Confidence Intervals
Warfare
Injury Severity Score
Registries
Thorax
Spleen
Multivariate Analysis
Kidney
Lung

Keywords

  • Noncompressible torso hemorrhage
  • Vascular trauma
  • Wartime injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

The epidemiology of noncompressible torso hemorrhage in the wars in Iraq and Afghanistan. / Stannard, Adam; Morrison, Jonathan J.; Scott, Daniel J.; Ivatury, Rebecca A.; Ross, James; Rasmussen, Todd E.

In: Journal of Trauma and Acute Care Surgery, Vol. 74, No. 3, 03.2013, p. 830-834.

Research output: Contribution to journalArticle

Stannard, Adam ; Morrison, Jonathan J. ; Scott, Daniel J. ; Ivatury, Rebecca A. ; Ross, James ; Rasmussen, Todd E. / The epidemiology of noncompressible torso hemorrhage in the wars in Iraq and Afghanistan. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 74, No. 3. pp. 830-834.
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