Comparison of female and male casualty cohorts from conflicts in Iraq and Afghanistan.

Although there has been interest in the literature regarding the casualties within the recent US military conflicts in Iraq and Afghanistan, very little to date has looked specifically at a difference between the sexes. As the role of the female Soldier has changed over the years, so have the risk and the nature of the female casualty. Combat injuries in women are an important medical consideration that has yet to be studied. For the purposes of this study, the following questions pertained: Do female and male casualties from the US military in recent conflicts differ in age, service, rank, military operation, or other demographic characteristics? Do female and male casualties from the US military in recent conflicts differ in their injury characteristics such as Injury Severity Score (ISS), Abbreviated Injury Score (AIS), injury type (blunt versus penetrating), injury cause (mechanism of injury), and injury date? The Department of Defense Trauma Registry (DoDTR) was queried, returning results for 425 female and 14,982 male subjects who sustained musculoskeletal injuries from October 2003 (beginning of hostilities in Iraq) to December 2012. The female and male cohorts were compared and analyzed for significance in demographics (age, service, rank, and military operation) and injury characteristics (ISS, AIS, injury type, injury cause, and injury date). Female casualties differ from their male counterparts in that they are slightly younger (F=26.11, M=27.83 years; P<.001), proportionally more female casualties were in the Army (F=81.5%, M=72.2%; P<.001), and proportionally more women were injured during Operation Iraqi Freedom (F=75.6%, M=63.2%; P<.001). Female casualties showed on average lower ISS (F=7.49; M=9.68; P<.001) and lower AIS specific to the skeletal anatomic region (F=2.06; M=2.36; P<.001); however when broken down into battle versus nonbattle injury, the difference disappeared. Women were less likely to be injured in battle (F=33.1%; M=70.9%; P<.001) and less likely to be injured due to an explosive device (F=27.7%, M=55.2%; P<.001). Women comprised 2.75% of the DoDTR casualties during the studied time frame and were less likely to be involved in explosions or during battle. The ISS were significantly different when comparing battle and nonbattle injuries for both of the sexes. However, since men were more likely to be injured in battle, their total ISS mean was higher.