Department of General Surgery, San Antonio Military Medical Center Department of General Surgery, Fort Sam Houston, Texas, USA.
J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S514-9.
Mortality from thoracic injuries has declined significantly from 63% in the Civil War to 3% in Vietnam. We reviewed the injury patterns, procedures, blood products, and mortality of US soldiers sustaining a thoracic injury during Operation Enduring Freedom and Iraqi Freedom (OEF/OIF).
Data on US soldiers with a thoracic injury during OEF/OIF from January 2003 to May 2011 was collected from the Joint Theater Trauma Registry. Coalition forces, civilians, and soldiers killed in action were excluded. Injuries and procedures were identified using DRG International Classification of Diseases-9th Rev. and Abbreviated Injury Scale (AIS) codes. Data are presented as mean (SD). Statistical analysis used χ analysis and t test where appropriate.
Thoracic injuries occurred in 2,049 of 23,797 wounded US military personnel for a prevalence of 8.6%. Mean (SD) age was 26 (6.6) years, and mean (SD) chest AIS score was 2.9 (0.9). Penetrating trauma was the most common mechanism of injury (61.5%), and explosive devices were the most common cause of injury (61.9%). Of 6,030 thoracic injuries identified, pneumothorax and pulmonary contusions were most common (51.8% and 50.2%, respectively). Of 1,541 surgical procedures performed in theater, the most common was tube thoracostomy (47.1%). Most patients with penetrating fragmentation injuries (84%) were managed with tube thoracostomy as sole therapeutic intervention. The fresh frozen plasma-to-packed red blood cells ratio was 0.86. Overall mortality was 8.3%. Acute respiratory distress syndrome and inhalation injury were associated with mortality (p < 0.006).
Most penetrating fragmentation injuries can be managed with tube thoracostomy. Mortality of patients with chest injury in OEF/OIF is higher than in Korea and Vietnam. This most likely represents advances in prehospital care, personal protective equipment, and rapid transport that have resulted in more severely injured patients arriving alive to a medical facility.
Epidemiologic study, level IV.
从内战时期的 63%降至越南战争时期的 3%，胸部创伤导致的死亡率显著下降。我们回顾了在持久自由行动和伊拉克自由行动（OEF/OIF）期间，美国士兵胸部受伤的受伤模式、手术程序、血液制品和死亡率。
从 2003 年 1 月至 2011 年 5 月，从联合战区创伤登记处收集了在 OEF/OIF 期间发生胸部损伤的美国士兵的数据。排除了联军部队、平民和阵亡士兵。使用 DRG 国际疾病分类第 9 修订版和简明损伤分级（AIS）代码确定损伤和手术。数据以平均值（标准差）表示。适当使用 χ 检验和 t 检验进行统计分析。
在 23797 名受伤美军人员中，胸部受伤发生在 2049 名人员中，发生率为 8.6%。平均（标准差）年龄为 26（6.6）岁，平均（标准差）胸部 AIS 评分为 2.9（0.9）。穿透性创伤是最常见的损伤机制（61.5%），爆炸装置是最常见的损伤原因（61.9%）。在确定的 6030 例胸部损伤中，气胸和肺挫伤最为常见（分别为 51.8%和 50.2%）。在 theater 进行的 1541 例手术中，最常见的是胸腔引流管（47.1%）。大多数穿透性碎片伤患者（84%）仅接受胸腔引流管作为单一治疗干预。新鲜冷冻血浆与浓缩红细胞的比例为 0.86。总体死亡率为 8.3%。急性呼吸窘迫综合征和吸入性损伤与死亡率相关（p<0.006）。
大多数穿透性碎片伤可以通过胸腔引流管进行治疗。OEF/OIF 中胸部损伤患者的死亡率高于朝鲜和越南。这很可能代表了在院前护理、个人防护设备和快速转运方面的进步，使更多严重受伤的患者活着到达医疗机构。
流行病学研究，IV 级。
