title: Analysis of battlefield head and neck injuries in Iraq and Afghanistan.
abstract: OBJECTIVE
  At the time of this study, the 1st place that an injured or ill American soldier in Iraq or Afghanistan would have been evaluated by an ENT-head and neck surgeon was at a tertiary care medical center as a result of air evacuation out of theater: Landstuhl Regional Medical Center (LRMC), Ramstein, Germany. By examining the ENT-related diagnoses of all air evacuations from downrange, we were able to match the patients classified as having battle injuries to determine the percentage with head and neck trauma.
  
  
  METHODS
  A prospective review of 11,287 soldiers air-evacuated from Afghanistan and Iraq, representing the 1st year of combat operations. A new, computerized patient-tracking system was created by our team to merge several disparate databases to generate and compile our data.
  
  
  RESULTS
  The ENT-head and neck surgery department evaluated and primarily managed 8.7% of all patients evacuated out of theater by air to Germany. Other medical and surgical services managed 7.3% of all patients evacuated out of theater with overlapping ENT diagnoses. The number of potential ENT patients increased to 16% when one looked at all head and neck pathology instances seen by all medical and surgical departments hospitalwide. Of all patients air-evacuated and classified as having battle injuries, 21% presented with at least 1 head and neck trauma code.
  
  
  CONCLUSIONS
  This is the 1st paper focusing on the role of the ENT-head and neck surgeon in treating a combat population and also the patterns of illness and head and neck injuries in a deployed force in our modern military. Improved soldier body armor has resulted in distinctly new patterns of combat injuries. Unprotected areas of the body account for the majority of injuries.
  
  
  CONCLUSIONS
  These findings should be used to improve the planning and delivery of combat medical care.
authors.affiliation: 435 Medical Group at Landstuhl Regional Medical Center of the US Air Force, MacDill AFB, Tampa, Florida, USA. michael.xydakis@travis.af.mil
authors.forename: Michael S
authors.initials: MS
authors.lastname: Xydakis
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fravell
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Nasser
authors.forename: John D
authors.initials: JD
authors.lastname: Casler
mesh_terms: D000328:Adult; D000346:Afghanistan; D006259:Craniocerebral Trauma / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D038801:International Classification of Diseases; D007493:Iraq; D008887:Military Medicine / Q000458:organization & administration*; D019838:Neck Injuries / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D010036:Otolaryngology / Q000458:organization & administration*; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000458:organization & administration*; D014481:United States; D014857:Warfare