title: UK combat-related pelvic junctional vascular injuries 2008-2011: implications for future intervention.
abstract: In a recent publication, 297 of 6450 (4.6%) military coalition deaths over ten years were reported to be due to junctional bleeding. The authors suggested that some of these deaths could have been avoided with a junctional haemorrhage control device. Prospectively collected data on all injuries sustained in Afghanistan by UK military personnel from 1 August 2008 to 31 July 2011 period were reviewed, using the UK Joint Theatre Trauma Registry. All fatalities with significant pelvic injuries were identified and analysed, and the cause of death established to assess the potential role for a junctional haemorrhage control device. Significant upper thigh, groin or pelvic injuries were recorded in 124 casualties, of which 93 died. Of these the pelvic injury was the cause of death in 37, but only 1 casualty with potentially survivable injuries was identified where death was due to a vascular injury below the inguinal ligament, not controlled by a CAT. This represents <1% of all deaths in this period, a lower figure than previously published. We further identified 32 casualties where the cause of death was due to a vascular injury between the aortic bifurcation and the inguinal ligament. Eight of these survived to a medical facility but subsequently died of their wounds. These represent a subset in which vascular control proximal to the inguinal ligament could have altered the outcome. Some potentially survivable deaths due to exsanguination may be amenable to proximal vascular control. Our study does not substantiate previous conclusions that this can be achieved through use of a groin junctional tourniquet. We believe there may be a role for more proximal vascular control of pelvic bleeding, and this merits further research.
authors.affiliation: The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham, United Kingdom; The Royal British Legion Centre for Blast Injury Studies, Imperial College London, United Kingdom. Electronic address: n.walker11@ic.ac.uk.
authors.forename: N M
authors.initials: NM
authors.lastname: Walker
authors.affiliation: The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham, United Kingdom.
authors.forename: W
authors.initials: W
authors.lastname: Eardley
authors.affiliation: The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham, United Kingdom; The Royal British Legion Centre for Blast Injury Studies, Imperial College London, United Kingdom.
authors.forename: J C
authors.initials: JC
authors.lastname: Clasper
mesh_terms: D000005:Abdomen / Q000098:blood supply; D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery*; D055826:Afghan Campaign 2001-; D002423:Cause of Death; D058734:Exsanguination; D005260:Female; D005835:Genitalia / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D006470:Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008887:Military Medicine; D008889:Military Personnel / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery*; D010388:Pelvis / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D011482:Protective Devices / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D014111:Tourniquets; D006113:United Kingdom; D057772:Vascular System Injuries / Q000209:etiology / Q000401:mortality / Q000601:surgery*
keywords: Pelvis; Tourniquets; Trauma; Vascular injuries