US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S496-502. doi: 10.1097/TA.0b013e318275473c.
US combat operations in Iraq and Afghanistan have resulted in a greater proportion of service members with head and neck wounds caused by explosions compared with that of previous wars. Although penetrating traumatic brain injury (TBI) is frequently associated with these wounds, the epidemiology of penetrating TBI from these conflicts has not been well described.
The Joint Theater Trauma Registry was queried for January 2003 through December 2010 to identify all patients with moderate-to-severe brain injury with a maximum Abbreviated Injury Scale (AIS) score of the head of 3 or greater and a diagnosis of penetrating or closed TBI in accordance with the Department of Defense Traumatic Brain Injury Surveillance definition. The epidemiology of these injuries was examined, including demographics, TBI severity, overall injury severity, and surgical interventions provided.
A total of 1,255 TBI patients (774 penetrating, 481 closed) meeting criteria were identified. Penetrating brain injuries were more severe, more likely to be battle related, and less likely to be isolated injuries than a group of moderate-to-severe closed TBIs within the same range of anatomic injury severity. During the 5-year period of the Iraq war with the largest numbers of TBIs (2004-2008), the numbers of penetrating TBIs exceeded closed TBIs by a ratio of 2:1. During the 3-year period of the Afghanistan war with the greatest numbers of TBIs (2008-2010), the ratio of penetrating to closed TBIs was substantially lower, approximately 1.3:1.
This study represents the first comprehensive report on the epidemiology of moderate-to-severe penetrating and closed TBIs resulting from the wars in Iraq and Afghanistan using Joint Theater Trauma Registry data. With the maturing theater of conflicts, penetrating TBIs were substantially less predominant compared with closed TBIs. While this finding may reflect changes in the use of protective measures and tactics or improvements in diagnosis of closed TBIs, additional research is needed to identify the reason for this shift and the subsequent effect on outcome after combat-related TBIs.
Epidemiologic study, level III.
美国在伊拉克和阿富汗的作战行动导致与之前的战争相比，有更多的士兵头部和颈部因爆炸而受伤。虽然穿透性创伤性脑损伤（TBI）经常与这些伤口有关，但这些冲突中穿透性 TBI 的流行病学尚未得到很好的描述。
通过联合战区创伤登记处，从 2003 年 1 月到 2010 年 12 月，确定了所有中度至重度脑损伤患者，其最大损伤严重程度评分（AIS）头部为 3 或更高，并且根据国防部创伤性脑损伤监测定义诊断为穿透性或闭合性 TBI。检查了这些损伤的流行病学，包括人口统计学、TBI 严重程度、总体损伤严重程度和提供的手术干预。
共确定了 1255 名符合条件的 TBI 患者（774 例穿透性，481 例闭合性）。与同一解剖损伤严重程度范围内的一组中度至重度闭合性 TBI 相比，穿透性脑损伤更严重，更可能与战斗有关，并且不太可能是孤立性损伤。在伊拉克战争的 5 年期间（2004-2008 年），TBI 数量最多，穿透性 TBI 是闭合性 TBI 的两倍。在阿富汗战争的 3 年期间（2008-2010 年），TBI 数量最多，穿透性 TBI 与闭合性 TBI 的比例大幅降低，约为 1.3:1。
这项研究使用联合战区创伤登记处的数据，代表了第一次对伊拉克和阿富汗战争中中度至重度穿透性和闭合性 TBI 的流行病学进行的全面报告。随着战区冲突的成熟，穿透性 TBI 明显比闭合性 TBI 更为普遍。虽然这一发现可能反映了保护措施和战术的使用变化或闭合性 TBI 诊断的改进，但需要进一步研究以确定这种转变的原因以及对战斗相关 TBI 后结果的后续影响。
流行病学研究，三级。
