title: Mortality and morbidity from combat neck injury.
abstract: BACKGROUND
  Neck injury represents 11% of battle injuries in UK forces in comparison with 2% to 5% in US forces. The aim of this study was to determine the causes of death and long-term morbidity from combat neck injury in an attempt to recommend new methods of protecting the neck.
  
  
  METHODS
  Hospital and postmortem records for all UK servicemen sustaining battle injuries to the neck between January 1, 2006 and December 31, 2010 were analyzed.
  
  
  RESULTS
  Neck wounds were found in 152 of 1,528 (10%) of battle injured service personnel. Seventy-nine percent of neck wounds were caused by explosions and were associated with a mortality rate of 41% compared with 78% from gunshot wounds (GSWs). Although current UK OSPREY neck collars can potentially protect zone I from explosive fragments, in the 58% in which the wearing of a neck collar was known, all service personnel chose not to wear the collar. The most common cause of death from explosive fragments was vascular injury (85%). Zone II was the most commonly affected area overall by explosive fragments and had the highest mortality but zone I was associated with the highest morbidity in survivors.
  
  
  CONCLUSIONS
  Nape protectors, that cover zone III of the neck posteriorly, would only have potentially prevented 3% of injuries and therefore this study does not support their use. Current UK OSPREY neck collars potentially protect against the majority of explosive fragments to zones I and II and had these collars been worn potentially 16 deaths may have been prevented. Reasons for their lack of uptake by UK servicemen is therefore being evaluated. Surface wound mapping of penetrating explosive fragments in our series has been used to validate the area of coverage required for future designs of neck protection.
authors.affiliation: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Breeze
authors.forename: Lucy S
authors.initials: LS
authors.lastname: Allanson-Bailey
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Hunt
authors.forename: Russell S
authors.initials: RS
authors.lastname: Delaney
authors.forename: Alan E
authors.initials: AE
authors.lastname: Hepper
authors.forename: Jon
authors.initials: J
authors.lastname: Clasper
mesh_terms: D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008889:Military Personnel / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D019838:Neck Injuries / Q000453:epidemiology / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D006113:United Kingdom / Q000208:ethnology