Oral-Maxillofacial Injury Surveillance of U.S. Military Personnel in Iraq and Afghanistan, 2001 to 2014.
Cranial and oral-maxillofacial injuries accounted for 33% of military visits to in-theater (Level III) military treatment facilities for battle injuries during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Even after years of conflict, the size and scope of oral-maxillofacial injuries in military armed conflict is still not fully understood. This study reports U.S. Department of Defense (DoD) rates of oral-maxillofacial injuries that can be used for further surveillance and research.
The populations studied were military personnel deployed to Afghanistan in OEF or Iraq in OIF and Operation New Dawn (OND), who sought care at a Level III military treatment facility for one or more oral-maxillofacial injuries. Injuries were identified in the DoD Trauma Registry (DoDTR) using diagnosis codes associated with oral-maxillofacial battle and nonbattle injuries. All oral-maxillofacial injuries incurred from October 19, 2001, to June 30, 2014, were included. The Defense Manpower Data Center provided DoD troop strength numbers to serve as the study denominators.
Battle injuries accounted for 80% of oral-maxillofacial injuries in OEF. There were 2,504 oral-maxillofacial injuries in OEF. The Army accounted for 1,820 (72.7%), the Marines 535 (21.3%), the Air Force 75 (3.0%), and the Navy 74 (3.0%). The oral-maxillofacial injury rates in OEF for the Army ranged from 1.10 to 4.90/1,000 person years (PY), for the Marines from 0.57 to 9.39/1,000 PY, for the Navy from 0 to 3.29/1,000 PY, and for the Air Force from 0 to 3.38/1,000 PY. The Army tended to have the highest incidence of all services in the early and latter part of the conflict, whereas Marines tended to have the highest incidence in the middle years. The Marines, Army, and Navy all had their individual highest incidences in 2009, the first year of the 2009 to 2011 OEF troop surge. Battle injuries accounted for 75% of oral-maxillofacial injuries in OIF/OND. There were 3,676 oral-maxillofacial injuries in OIF/OND. The Army accounted for 2,798 (76.1%), the Marines 731 (19.9%), the Navy 91 (2.5%), and the Air Force 56 (1.5%). The injury rates in OIF/OND for the Army ranged from 0.66 to 8.69/1,000 PY, for the Marines from 0.88 to 42.7/1,000 PY, for the Navy from 0.35 to 19.16/1,000 PY, and for the Air Force from 0.24 to 1.13/1,000 PY. In OIF/OND, the Marines had the highest overall oral-maxillofacial injury rate (42.70/1,000 PY) in 2003. The other services had their individual peak incidences in either 2003 or 2004.
This is the first study, which quantified the incidence of oral-maxillofacial injury in theaters of conflict over prolonged periods. The Army has the highest number of injuries. The Marines had the highest incidences during the initial stages of OIF and the OEF troop surge. Intensity of the conflict could account for the upswing in rates. These increases in injury rates highlight the need for additional health care personnel to be deployed near the battlefield to treat these injuries.
Mitchener TA
，Chan R
，Simecek JW
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Non-battle craniomaxillofacial injuries from U.S. military operations.
Non-battle injuries (NBIs) can be a source of significant resource utilization for the armed forces in a deployed setting. While the incidence and severity of craniomaxillofacial (CMF) battle injuries (BIs) have reportedly increased in the ongoing U.S. military conflicts in Iraq and Afghanistan, the prevalence and the nature of NBIs are not well described.
The Joint Theater Trauma Registry was queried from October 2001 to February 2011, covering Operations Enduring Freedom and Iraqi Freedom, for both NBIs and BIs to the CMF region. Patient demographics, injury severity score, mechanism and type of injury were included in the query. Using ICD-9 diagnosis codes, CMF injuries were classified according to type (wounds, fractures, burns, vascular injuries, and nerve injuries). Statistical analysis was performed for comparative analysis.
NBIs constituted 24.3% of all patients with CMF injuries evacuated to a regional combat support hospital (CMF BIs 75.4%). These injuries were characterized by blunt trauma, most commonly motor vehicle collisions (37%), and falls (20%). As compared to CMF BIs, CMF NBIs resulted in less mortality (1.3% vs. 3.1%, p < 0.0001), fewer injuries per patient (1.87 vs. 2.26, p = 0.055), and a decreased severity score (ISS) (8.38 vs. 12.98, p < 0.0001). However, a significant percentage of CMF NBIs still required evacuation out of theater (27.8% of NBIs vs. 42.2% of BIs, p < 0.0001), depleting the combat strength of the deployed forces.
CMF NBIs accounted for a substantial portion of total CMF injuries. Though characterized predominantly by blunt trauma with an overall better prognosis, its burden to the limited resources of a deployment can be significant. This descriptive study highlights the need to allocate appropriate resources for treatment of these injuries as well as strategies to reduce both its incidence and severity.
IV Prognostic.
Madson AQ
，Tucker D
，Aden J
，Hale RG
，Chan RK
... -
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Causes of Death in Military Working Dogs During Operation Iraqi Freedom and Operation Enduring Freedom, 2001-2013.
Military working dogs (MWDs) are a major asset in the theater of operations. Their unique abilities make them ideal for tasks such as tracking, patrol, and scent detection. MWDs deployed to a war zone are exposed to harsh environments and battlefield dangers that increase their risk of disease, injuries, and death. Although canines have been used extensively in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), no published studies have reported detailed causes of death among MWDs deployed to these conflicts.
Potential cases were defined as U.S. military-owned MWDs that died while deployed in Iraq (OIF) or Afghanistan (OEF) from January 1, 2001 through December 31, 2013 and identified from both official sources and unofficial sources, that is, online searches. Cases included in this study were limited to MWDs with data on cause of death obtained by abstraction from official veterinary treatment records (VTRs) from the Department of Defense Military Working Dog Veterinary Service, Joint Base San Antonio-Lackland Air Force Base, San Antonio, Texas, and Special Operations Forces units.
We identified 92 MWDs that died while deployed to OEF/OIF from 2001 through 2013 and had cause of death information from official VTRs. For both OEF and OIF, the most common training program was Multi-Purpose Canine (36.5% and 51.7%, respectively), followed by Improvised Explosive Detector Dog for OEF (34.9%) and Patrol Explosive Detector Dog for OIF (34.5%). Injuries were the primary cause of death for 77.2% of the MWDs for which we had cause of death data. The most frequent external injuries were gunshot wounds (GSW) (31.5%), explosion or blast (26.1%), and heat stress (9.8%). The proportion of deaths due to GSW was similar for OEF and OIF (30.2% vs. and 34.5%, respectively). However, a greater proportion of MWDs died from explosions during OEF than during OIF (30.2% vs. 17.2%, respectively). Diseases were the cause of death in 23.0% of the MWDs. The most common diseases were gastric dilation and volvulus (GDV, n = 3), pleuritis (n = 2), and sepsis (n = 3). Two deaths were associated with anesthesia-related medical procedures. A total of 8.7% of cases were missing cause of death, 8.7% were missing age, 32.6% of cases were missing data on necropsy, and 14.1% were missing data on final disposition of the body. Other variables of interest including number of deployments and duration of training had a very high proportion of missing values and thus could not be analyzed.
Our study is the most comprehensive to date that reports causes of death of MWDs deployed to OIF and OEF. However, limitations in the available data lessen the potential of our results to inform improvements in training and point of injury medical care. Better documentation in VTRs and systematic data collection into an official MWD trauma registry could lead to improved training and facilitate further development and evaluation of guidelines to improve care of wounded MWDs in future conflicts.
Miller L
，Pacheco GJ
，Janak JC
，Grimm RC
，Dierschke NA
，Baker J
，Orman JA
... -
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