Dismounted Blast Injuries in Patients Treated at a Role 3 Military Hospital in Afghanistan: Patterns of Injury and Mortality.
The purposes of this study are to define the pattern of injuries sustained by dismounted troops exposed to improvised explosive devices blasts treated at a Role 3 combat support hospital and to assess injury patterns and mortality associated with the mechanism. Our hypothesis was that mortality is associated with pelvic fracture, massive transfusion, high Injury Severity Score (ISS), multiple limb amputations, and transfer from a Role 2 facility.



Retrospective study of 457 patients. Analysis performed on trauma registry data and systematic review of radiographs.



99.9% were men with a median age of 23 years and median ISS 10. 141 patients (30.9%) required massive blood transfusion. Limb amputations were frequently observed injuries, 109 of 172 amputees (63.4%) had a double amputation. 34 subjects (7.4%) had pelvic fractures; majority of pelvic fractures (88%) were unstable (Tile B or C). Risk factors associated with the overall mortality rate of 1.8% were an ISS greater than 15 (odds ratio: 11.5; 95% confidence interval: 1.38, 533; p = 0.009), need for massive transfusion (p < 0.0001), and the presence of a pelvic fracture (odds ratio: 7.63; 95% confidence interval: 1.13, 41.3; p = 0.018).



Dismounted improvised explosive devices blast injuries result in devastating multiple limb amputations and unstable pelvic fractures, which are associated with mortality after initial trauma resuscitation at a Role 3 hospital.
Department of Surgery, 8901 Wisconsin Avenue, Walter Reed National Military Medical Center, Bethesda, MD 20889.
John S
JS
Oh
Department of Orthopedics and Rehabilitation, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Creighton C
CC
Tubb
Department of Orthopedic Surgery, Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223.
Thomas P
TP
Poepping
Department of Orthopedic Surgery, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431.
Paul
P
Ryan
Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham B15 2SQ, United Kingdom.
Jonathan C
JC
Clasper
Department of Trauma and Critical Care, Landstuhl Regional Medical Center, APO AE 09180, Germany.
Adrian R
AR
Katschke
Department of Trauma and Critical Care, Landstuhl Regional Medical Center, APO AE 09180, Germany.
Caroline
C
Tuman
Department of Anesthesia, 5777 East Mayo Boulevard, Phoenix, AZ 85054.
Michael J
MJ
Murray
D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D000673:Amputation, Traumatic / Q000453:epidemiology; D001753:Blast Injuries / Q000453:epidemiology* / Q000401:mortality*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology / Q000628:therapy; D006772:Hospitals, Military / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D010388:Pelvis / Q000293:injuries; D012189:Retrospective Studies; D014857:Warfare