Three Interventions Involved in Decrease in Combat Mortality

Increased use of tourniquets, blood transfusions, rapid prehospital transport time key to mortality reduction

FRIDAY, March 29, 2019 (HealthDay News) -- Increased use of tourniquets, blood transfusions, and more rapid prehospital transport time accounted for 44.2 percent of the total mortality reduction seen over time in Afghanistan and Iraq, according to a study published online March 27 in JAMA Surgery.

Jeffrey T. Howard, Ph.D., from the University of Texas at San Antonio, and colleagues retrospectively analyzed data for all 56,763 U.S. military casualties injured in battle in Afghanistan and Iraq from Oct. 1, 2001, through Dec. 31, 2017. The authors examined the impact of interventions (tourniquet use, blood transfusions, and transport to a surgical facility within 60 minutes).

The researchers found that from early to later stages of the conflicts, the case-fatality rate (CFR) decreased in Afghanistan (from 20.0 to 8.6 percent) and in Iraq (from 20.4 to 10.1 percent). For critically injured casualties, survival increased in Afghanistan (from 2.2 to 39.9 percent) and in Iraq (from 8.9 to 32.9 percent). In simulations using data from 23,699 individual casualties, without the interventions assessed, CFR would likely have been higher in Afghanistan and Iraq (estimated, 15.6 and 16.3 percent, respectively), equivalent to 3,672 additional deaths. Of these deaths, 44.2 percent were associated with the interventions studied: 12.9, 23.8, and 7.5 percent with use of tourniquets, blood transfusion, and prehospital transport times, respectively.

"The knowledge gained about the contributions of this critical combination of lifesaving interventions should be implemented in civilian and military trauma care," write the authors of an accompanying editorial.

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