Wartime thoracic injury: perspectives in modern warfare.

BACKGROUND: Thoracic injury represents a major source of combat morbidity and mortality. The overall killed-in-action rate has decreased, whereas the died-of-wounds rate has increased; the creation of the Joint Theater Trauma Registry allows for improved documentation. This report seeks to provide a realistic contemporary look at thoracic injury sustained by military forces and civilian casualties during the current wartime experience.

METHODS: The Joint Theater Trauma Registry was queried between 2002 and 2008. Patients receiving treatment for thoracic injuries were identified using International Classification of Diseases, 9th edition, diagnosis and procedure codes. All US soldiers, coalition forces, and local civilians were included in the analysis.

RESULTS: There were 33,755 casualties identified during the study period, of which 1,660 patients (4.9%) sustained thoracic injury. Blast mechanism was the most prominent mode of injury, accounting for 45.8%. The mean Injury Severity Score in this cohort of patients was 14.9. A total of 4,232 procedures were performed, resulting in an average of 2.5 thoracic procedures per patient. Fifty percent of casualties were civilian, and 34% were US troops, with the remainder occurring in coalition forces. Overall mortality was 12%.

CONCLUSIONS: This report provides a realistic account of current wartime thoracic injury. In contrast to previous wars, the majority of thoracic injury is secondary to blast injury as opposed to penetrating trauma, and the resultant mortality rate is higher. This report breaks down thoracic injuries to both US troops and civilian personal and provides realistic expectations for thoracic injury during future combat planning.