title: Management and outcomes of traumatic colon injury in civilian and military patients.
abstract: Divergent injury patterns may indicate the need for differing strategies in combat and civilian trauma patients. This study aims to compare outcomes of colon injury management in these two populations. Parallel retrospective reviews were conducted comparing warfighters (n = 59) injured  downrange and subsequently transferred to the United States with civilians (n = 30) treated at a United States Level I trauma center. Patient characteristics, mechanisms of injury, treatment course, and complications were compared. The civilian (CP) and military (MP) populations did not differ  in Injury Severity Score (MP 20 vs CP 26; P = 0.41). The MP experienced primarily blast injuries (51%) as opposed to blunt trauma (70%; P < 0.01) in the CP. The site of colon injury did not differ between groups (P = 0.15). Initial management was via primary  repair (53%) and resection and anastomosis (27%) in the CP versus colostomy creation (47%) and stapled ends (32%) in the MP (P < 0.001). Ultimately, the CP and MP experienced equivalent continuity rates (90%). Overall complications (MP 68% vs CP 53%; P = 0.18) and mortality  (MP 3% vs CP 3%; P = 0.99) did not differ between the two groups. The CP and MP experience different mechanisms and initial management of colon injury. Ultimately, continuity is restored in the majority of both populations.
authors.affiliation: Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.
authors.forename: Chitra N
authors.initials: CN
authors.lastname: Sambasivan
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Underwood
authors.forename: Reed B
authors.initials: RB
authors.lastname: Kuehn
authors.forename: S D
authors.initials: SD
authors.lastname: Cho
authors.forename: Laszlo N
authors.initials: LN
authors.lastname: Kiraly
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Hamilton
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Flaherty
authors.forename: Warren C
authors.initials: WC
authors.lastname: Dorlac
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000293:injuries* / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult