title: The UK military experience of thoracic injury in the wars in Iraq and Afghanistan.
abstract: BACKGROUND
  Thoracic injury during warfare is associated with a high incidence of morbidity and mortality. This study examines the pattern and mortality of thoracic wounding in the counter-insurgency conflicts of Iraq and Afghanistan, and outlines the operative and decision making skills required by the modern military surgeon in the deployed hospital setting to manage these injuries.
  
  
  METHODS
  The UK Joint Theatre Trauma Registry was searched between 2003 and 2011 to identify all patients who sustained battle-related thoracic injuries admitted to a UK Field Hospital (Role 3). All UK soldiers, coalition forces and local civilians were included.
  
  
  RESULTS
  During the study period 7856 patients were admitted because of trauma, 826 (10.5%) of whom had thoracic injury. Thoracic injury-related mortality was 118/826 (14.3%). There were no differences in gender, age, coalition status and mechanism of injury between survivors and non-survivors. Survivors had a significantly higher GCS, Revised Trauma Score and systolic blood pressure on admission to a Role 3 facility. Multivariable regression analysis identified admission systolic blood pressure less than 90, severe head or abdominal injury and cardiac arrest as independent predictors of mortality.
  
  
  CONCLUSIONS
  Blast is the main mechanism of thoracic wounding in the recent conflicts in Iraq and Afghanistan. Thoracic trauma in association with severe head or abdominal injuries are predictors of mortality, rather than thoracic injury alone. Deploying surgeons require training in thoracic surgery in order to be able to manage patients appropriately at Role 3.
authors: Academic Department of Military Surgery and Trauma (ADMST), Royal Centre for Defence Medicine, Birmingham, United Kingdom. hpoonie@doctors.net.uk
authors: H
authors: H
authors: Poon
authors: J J
authors: JJ
authors: Morrison
authors: A N
authors: AN
authors: Apodaca
authors: M A
authors: MA
authors: Khan
authors: J P
authors: JP
authors: Garner
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000209:etiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D001753:Blast Injuries / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D008887:Military Medicine / Q000193:education*; D013898:Thoracic Injuries / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000193:education*; D055815:Young Adult
keywords: Cardiac repair; Military trauma; Thoracic injury; Thoracotomy; Training