title: Clinical and post mortem analysis of combat neck injury used to inform a novel coverage of armour tool.
abstract: BACKGROUND
  There is a requirement in the Ministry of Defence for an objective method of comparing the area of coverage of different body armour designs for future applications. Existing comparisons derived from surface wound mapping are limited in that they can only demonstrate the skin entry wound location. The Coverage of Armour Tool (COAT) is a novel three-dimensional model capable of comparing the coverage provided by body armour designs, but limited information exists as to which anatomical structures require inclusion. The aim of this study was to assess the utility of COAT, in the assessment of neck protection, using clinically relevant injury data.
  
  
  METHODS
  Hospital notes and post mortem records of all UK soldiers injured by an explosive fragment to the neck between 01 Jan 2006 and 31 December 2012 from Iraq and Afghanistan were analysed to determine which anatomical structures were responsible for death or functional disability at one year post injury. Using COAT a comparison of three ballistic neck collar designs was undertaken with reference to the percentage of these anatomical structures left exposed.
  
  
  RESULTS
  13/81 (16%) survivors demonstrated complications at one year, most commonly upper limb weakness from brachial plexus injury or a weak voice from laryngeal trauma. In 14/94 (15%) soldiers the neck wound was believed to have been the sole cause of death, primarily from carotid artery damage, spinal cord transection or rupture of the larynx. COAT objectively demonstrated that despite the larger OSPREY collar having almost double the surface area than the two-piece prototype collar, the percentage area of vulnerable cervical structures left exposed only reduced from 16.3% to 14.4%.
  
  
  CONCLUSIONS
  COAT demonstrated its ability to objectively quantify the potential effectiveness of different body armour designs in providing coverage of vulnerable anatomical structures from different shot line orientations. To improve its utility, it is recommended that COAT be further developed to enable weapon and tissue specific information to be modelled, and that clinically significant injuries to other body regions are also incorporated.
authors: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham B15 2SQ, United Kingdom. Electronic address: johno.breeze@me.com.
authors: J
authors: J
authors: Breeze
authors: Land Battlespace Systems Department, Defence Science & Technology Laboratory, Portsdown West, Fareham PO17 6AD, Hampshire, United Kingdom.
authors: R
authors: R
authors: Fryer
authors: Land Battlespace Systems Department, Defence Science & Technology Laboratory, Portsdown West, Fareham PO17 6AD, Hampshire, United Kingdom.
authors: J
authors: J
authors: Hare
authors: South West Forensic Pathology Group Practice, PO Box 388, Bristol BS9 0DB, United Kingdom.
authors: R
authors: R
authors: Delaney
authors: Forensic Pathology Services, Culham Science Centre, Abingdon, Oxford OX14 3ED, United Kingdom.
authors: N C
authors: NC
authors: Hunt
authors: Defence Equipment and Support, Ministry of Defence Abbey Wood, Bristol BS34 8JH, United Kingdom.
authors: E A
authors: EA
authors: Lewis
authors: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham B15 2SQ, United Kingdom; The Royal British Legion Centre for Blast Injury Studies at Imperial College London, London, United Kingdom.
authors: J C
authors: JC
authors: Clasper
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D001344:Autopsy; D001753:Blast Injuries / Q000517:prevention & control*; D017076:Computer-Aided Design; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel; D019838:Neck Injuries / Q000517:prevention & control*; D011481:Protective Clothing; D011482:Protective Devices / Q000592:standards*; D006113:United Kingdom; D014948:Wounds, Gunshot / Q000517:prevention & control
keywords: Ballistic; Body armour; Cervical; Injury model; Military; Neck; Protection