• Philip J Belmont, Gens P Goodman, Michael Zacchilli, Matthew Posner, Clifford Evans, and Brett D Owens.
• Department of Surgery, Orthopaedic Surgery Service, William Beaumont Army Medical Center, 5005 North Piedras, El Paso, TX 79920, USA. philip.belmont@us.army.mil
• J Trauma. 2010 Jan 1;68(1):204-10.

BackgroundA prospective, longitudinal analysis of injuries sustained by a large combat-deployed maneuver unit has not been previously performed.MethodsA detailed description of the combat casualty care statistics, distribution of wounds, and mechanisms of injury incurred by a U.S. Army Brigade Combat Team during "The Surge" phase of Operation Iraqi Freedom was performed using a centralized casualty database and an electronic medical record system.ResultsAmong the 4,122 soldiers deployed, there were 500 combat wounds in 390 combat casualties. The combat casualty rate for the Brigade Combat Team was 75.7 per 1,000 soldier combat-years. The % killed in action (KIA) was 22.1%, and the %died of wounds was 3.2%. The distribution of these wounds was as follows: head/neck 36.2%, thorax 7.5%, abdomen 6.9%, and extremities 49.4%. The percentage of combat wounds showed a significant increase in the head/neck region (p < 0.0001) and a decrease in the extremities (p < 0.03) compared with data from World War II, Korea, and Vietnam. The percentage of thoracic wounds (p < 0.03) was significantly less than historical data from World War II and Vietnam. The %KIA was significantly greater in those soldiers injured by an explosion (26.3%) compared with those soldiers injured by a gunshot wound (4.6%; p = 0.003). Improvised explosive devices accounted for 77.7% of all combat wounds.ConclusionsThere was a significantly higher proportion of head/neck wounds compared with previous U.S. conflicts. The 22.1% KIA was comparable with previous U.S. conflicts despite improvements in individual/vehicular body armor and is largely attributable to the lethality of improvised explosive devices. The lethality of a gunshot wound in Operation Iraqi Freedom has decreased to 4.6% with the use of individual body armor.

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