Traumatic brain injury hospitalizations of U.S. army soldiers deployed to Afghanistan and Iraq.

BACKGROUND: Traumatic brain injury (TBI) is a life-altering condition that has affected many of our soldiers returning from war. In the current conflicts, the improvised explosive device (IED) has greatly increased the potential for soldiers to sustain a TBI. This study's objective was to establish benchmark admission rates for U.S. Army soldiers with TBIs identified during deployment to Iraq and Afghanistan. METHODS: The study population consisted of U.S. Army soldiers deployed to Iraq and Afghanistan from September 11, 2001, through September 30, 2007. Population data were merged with admission data to identify hospitalizations during deployment. Using the international Barell Injury Diagnosis Matrix, TBI-related admissions were categorized into Type 1 (the most severe), Type 2, and Type 3 (the least severe). All analyses were performed in 2008. RESULTS: Of the 2898 identified TBI inpatient episodes of care, 46% were Type 1, 54% were Type 2, and less than 1% were Type 3. Over 65% of Type 1 injuries resulted from explosions, while almost half of all TBIs were non-battle-related. Overall TBI admission rates were 24.6 for Afghanistan and 41.8 for Iraq per 10,000 soldier-years. TBI hospitalization rates rose over time for both campaigns, although U.S. Army soldiers in Iraq experienced 1.7 times higher rates overall and 2.2 times higher Type 1 admission rates than soldiers in Afghanistan. The TBI-related proportion of all injury hospitalizations showed an ascending trend. CONCLUSIONS: Future surveillance of TBI hospitalization rates is needed to evaluate the effectiveness of implementation of preventive measures.

Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006.

BACKGROUND: The opinion that injuries sustained in Iraq and Afghanistan have increased in severity is widely held by clinicians who have deployed multiple times. To continuously improve combat casualty care, the Department of Defense has enacted numerous evidence-based policies and clinical practice guidelines. We hypothesized that the severity of wounds has increased over time. Furthermore, we examined cause of death looking for opportunities of improvement for research and training. METHODS: Autopsies of the earliest combat deaths from Iraq and Afghanistan and the latest deaths of 2006 were analyzed to assess changes in injury severity and causes of death. Fatalities were classified as nonsurvivable (NS) or potentially survivable (PS). PS deaths were then reviewed in depth to analyze mechanism and cause. RESULTS: There were 486 cases from March 2003 to April 2004 (group 1) and 496 from June 2006 to December 2006 (group 2) that met inclusion criteria. Of the PS fatalities (group 1: 93 and group 2: 139), the injury severity score was lower in the first group (27 +/- 14 vs. 37 +/- 16, p < 0.001), and had a lower number of abbreviated injury scores >or=4 (1.1 +/- 0.79 vs. 1.5 +/- 0.83 per person, p < 0.001). The main cause of death in the PS fatalities was truncal hemorrhage (51% vs. 49%, p = NS). Deaths per month between groups doubled (35 vs. 71), whereas the case fatality rates between the two time periods were equivalent (11.0 vs. 9.8, p = NS). DISCUSSION: In the time periods of the war studied, deaths per month has doubled, with increases in both injury severity and number of wounds per casualty. Truncal hemorrhage is the leading cause of potentially survivable deaths. Arguably, the success of the medical improvements during this war has served to maintain the lowest case fatality rate on record.