Ikni Laura, Valbousquet Laura, Dufour-Gaume Frederique, Potet Julien
Percy Teaching Hospital, Clamart 92140, France.
Institut de recherche biomédicale des armées (IRBA), Brétigny-sur-Orge 91220, France.
Mil Med. 2025 Feb 27;190(3-4):e586-e592. doi: 10.1093/milmed/usae458.
High-intensity conflicts are on Europe's doorstep. The French expertise in the medical management of frontline casualties in overseas operations is well established. However, in the management of severe trauma, we lack data on the injuries identified by body scanners in the field. Understanding the associations between injury mechanisms and radiological lesions would enable us to anticipate medical and surgical management. To study this possible link, we collected and interpreted scanogaphic data and analyzed them according to lesion mechanisms, following the algorithm MARCH used to implement the concept of Damage Control Resuscitation, which includes life-saving measures to ensure that the wounded reach medical-surgical facilities alive.
This retrospective monocentric study collected data from body scanners performed in overseas operations between June 2011 and September 2023. Inclusion criteria were to be French military personnel and to have undergone a whole-body scanner in a theater of overseas operations. Exclusion criteria were to have died before the scan, to be foreign, non-military and a minor. Of 164 available files, 96 were eligible, 1 patient declared aged 70 years was excluded, and 95 files were retained.
In our population, 18% of injured patients had a spinal fracture. Compared with road traffic accident casualties, improvised explosive device casualties were the most severely injured patients arriving alive at computed tomography, with a relative risk of Injury Severity Score > 8 of 2.29 [1.09-4.80] (P = .019). Improvised explosive device casualties had a relative risk of airway injuries of 2.57 [1.03-6.39] (P = .030), injuries leading to functional impairment of 3.21 [1.17-8.82] (P =.013), injuries leading to infection of 2.14 [1.21-3.76] (P = .0045), and injuries leading to shock of 3.21 [0.96-10.70] (P = .039). Deep metal splinters were only found in the improvised explosive device group.
Preparing the medical corps to deal with war casualties is fundamental. Our study shows that it is essential to consider the mechanism of injury to understand the casualty better and predict potential injuries. In addition, the study of postmortem scans could greatly help analyze potentially avoidable deaths.
高强度冲突已逼近欧洲。法国在海外行动中对前线伤员进行医疗管理的专业能力已得到充分确立。然而，在严重创伤的管理方面，我们缺乏关于现场人体扫描仪所识别损伤的数据。了解损伤机制与放射学损伤之间的关联将使我们能够预测医疗和手术管理。为研究这种可能的联系，我们收集并解读了扫描数据，并根据损伤机制对其进行分析，遵循用于实施损伤控制复苏概念的MARCH算法，其中包括挽救生命的措施，以确保伤员活着抵达医疗手术设施。
这项回顾性单中心研究收集了2011年6月至2023年9月在海外行动中进行的人体扫描仪数据。纳入标准为法国军事人员且在海外行动战区接受过全身扫描仪检查。排除标准为在扫描前死亡、为外国人、非军事人员以及未成年人。在164份可用档案中，96份符合条件，排除1名申报年龄为70岁的患者，保留95份档案。
在我们的研究人群中，18%的受伤患者有脊柱骨折。与道路交通事故伤员相比，简易爆炸装置伤员是在计算机断层扫描时存活的伤势最严重的患者，损伤严重程度评分>8的相对风险为2.29[1.09 - 4.80](P = 0.019)。简易爆炸装置伤员气道损伤的相对风险为2.57[1.03 - 6.39](P = 0.030)，导致功能障碍的损伤相对风险为3.21[1.17 - 8.82](P = 0.013)，导致感染的损伤相对风险为2.14[1.21 - 3.76](P = 0.0045)，导致休克的损伤相对风险为3.21[0.96 - 10.70](P = 0.039)。仅在简易爆炸装置组中发现深部金属碎片。
让医疗队做好应对战争伤员的准备至关重要。我们的研究表明，考虑损伤机制对于更好地了解伤员并预测潜在损伤至关重要。此外，对死后扫描的研究可以极大地帮助分析潜在可避免的死亡。
