• John Breeze, Douglas M Bowley, James G Combes, James Baden, Linda Orr, Andrew Beggs, Joseph DuBose, and David B Powers.
• From the Royal Centre for Defence Medicine (J. Breeze); University Hospital Birmingham (J. Breeze, D.M.B., J. Baden, L.O.), Birmingham; Royal Surrey County Hospital (J.G.C.), Guildford; Surgical Research Laboratory (A.B.), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, United Kingdom; Center for the Sustainment of Trauma and Readiness Skills (J.D.), R Adams Cowley Shock Trauma Center, Baltimore, Maryland; and Duke University Medical Center (D.B.P.), Durham, North Carolina.
• J Trauma Acute Care Surg. 2020 May 1; 88 (5): 696-703.

IntroductionThe United States and United Kingdom (UK) had differing approaches to the surgical skill mix within deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan.MethodsThe US and UK combat trauma registries were scrutinized for patients with penetrating neck injury (PNI) at deployed coalition MTF between March 2003 and October 2011. A multivariate mixed effects logistic regression model (threshold, p < 0.05) was used stratified by MTF location and year of injury. The dependent variable was fatality on leaving Role 3, and the independent variables were ISS on arrival, nationality, MTF nationality, and presence of head and neck surgeon.ResultsA total of 3,357 (4.9%) of 67,586 patients who arrived alive at deployed military MTF were recorded to have sustained neck injuries; of which 2,186 (83%) were PNIs and the remainder were blunt injuries. When service members killed in action were included, the incidence of neck injury rose from 4.9% to 10%. Seven hundred nine (32%) of 2,186 patients with PNI underwent neck exploration; 555 patients were recorded to have sustained cervical vascular injury, 230 (41%) of 555 underwent vascular ligation or repair. Where it was recorded, PNI directly contributed to death in 64 (28%) of 228 of patients. Fatality status was positively associated with ISS on arrival (odds ratio, 1.05; 95% confidence interval, 1.04-1.06; p < 0.001) and the casualty being a local national (odds ratio, 1.74; 95% confidence interval, 1.28-2.38; p < 0.001).ConclusionSignificant differences in the treatment and survival of casualties with PNI were identified between nations in this study; this may reflect differing cervical protection, management protocols, and surgical capability and is worthy of further study. In an era of increasing specialization within surgery, neck exploration remains a skill that must be retained by military surgeons deploying to Role 2 and Role 3 MTF.Level Of EvidenceRetrospective cohort study, level III.

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