title: Improved characterization of combat injury.
abstract: BACKGROUND
  Combat injury patterns differ from civilian trauma in that the former are largely explosion-related, comprising multiple mechanistic and fragment injuries and high-kinetic-energy bullets. Further, unlike civilians, U.S. armed forces combatants are usually heavily protected with helmets and Kevlar body armor with ceramic plate inserts. Searchable databases providing actionable, statistically valid knowledge of body surface entry wounds and resulting organ injury severity are essential to understanding combat trauma.
  
  
  METHODS
  Two tools were developed to address these unique aspects of combat injury: (1) the Surface Wound Mapping (SWM) database and Surface Wound Analysis Tool (SWAT) software that were developed to generate 3D density maps of point-of-surface wound entry and resultant anatomic injury severity; and (2) the Abbreviated Injury Scale (AIS) 2005-Military that was developed by a panel of military trauma surgeons to account for multiple injury etiology from explosions and other high-kinetic- energy weapons. Combined data from the Joint Theater Trauma Registry, Navy/Marine Combat Trauma Registry, and the Armed Forces Medical Examiner System Mortality Trauma Registry were coded in AIS 2005-Military, entered into the SWM database, and analyzed for entrance site and wounding path.
  
  
  RESULTS
  When data on 1,151 patients, who had a total of 3,500 surface wounds and 12,889 injuries, were entered into SWM, surface wounds averaged 3.0 per casualty and injuries averaged 11.2 per casualty. Of the 3,500 surface wounds, 2,496 (71%) were entrance wounds with 6,631 (51%) associated internal injuries, with 2.2 entrance wounds and 5.8 associated injuries per casualty (some details cannot be given because of operational security). Crude deaths rates were calculated using Maximum AIS-Military.
  
  
  CONCLUSIONS
  These new tools have been successfully implemented to describe combat injury, mortality, and distribution of wounds and associated injuries. AIS 2005-Military is a more precise assignment of severity to military injuries. SWM has brought data from all three combat registries together into one analyzable database. SWM and SWAT allow visualization of wounds and associated injuries by region on a 3D model of the body.
authors.affiliation: Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
authors.forename: Howard R
authors.initials: HR
authors.lastname: Champion
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Mary M
authors.initials: MM
authors.lastname: Lawnick
authors.forename: Timothy
authors.initials: T
authors.lastname: Kelliher
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Spott
authors.forename: Michael R
authors.initials: MR
authors.lastname: Galarneau
authors.forename: Donald H
authors.initials: DH
authors.lastname: Jenkins
authors.forename: Susan A
authors.initials: SA
authors.lastname: West
authors.forename: Judy
authors.initials: J
authors.lastname: Dye
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Eastridge
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
authors.forename: Ellen Kalin
authors.initials: EK
authors.lastname: Shair
mesh_terms: D015998:Abbreviated Injury Scale; D001753:Blast Injuries / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D001830:Body Surface Area; D016208:Databases, Factual; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008887:Military Medicine; D008889:Military Personnel; D011481:Protective Clothing; D012042:Registries; D012984:Software; D014187:Transportation of Patients; D014193:Trauma Centers; D014194:Traumatology; D014481:United States / Q000453:epidemiology; D014857:Warfare; D014948:Wounds, Gunshot / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology