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www.armytimes.com February 02, 2005
Registry could cut war deaths
Data reporting system aims to improve care for wounded
By Deborah Funk
Times staff writer
About half of the U.S. troops in Iraq who are hospitalized with physical trauma are injured in battle, most often by improvised bombs, grenades, shrapnel, bullets and other penetrating devices.
And, regardless of whether they are wounded in or away from battle, few of these trauma patients return to duty — at least not immediately, according to preliminary military figures.
The inpatient data are in early reports from the Joint Theater Trauma Registry — the backbone of a new wartime trauma reporting system that will save lives and steer research, a top Army doctor said.
“I want to drive my research lab with the data that comes out of this war,” said Army Col. (Dr.) John Holcomb, commander of the U.S. Army Institute of Surgical Research.
“Right now, we’re using 40-year-old data. We’re obligated to have current data,” he said.
Using current data can cut preventable death by 15 percent by making sure the injured get the right care at the right place and time, and that proper resources are where they need to be, Holcomb said.
Holcomb stressed that the Joint Theater Trauma Registry is very much a work in progress.
As of Dec. 31, the database contained the records of 2,403 military inpatients treated in combat-support hospitals in Southwest and Central Asia and treatment records of 1,026 troops from among the larger group who were further evacuated to Landstuhl Regional Medical Center in Germany for follow-on care.
That represents only about 30 percent of all inpatient injuries to date in Operation Iraqi Freedom and Operation Enduring Freedom.
Trends could change
Holcomb said his staff has many more records but has not had time to enter them into the registry.
In addition, the data that have been entered are not in chronological order; the information is being entered as boxes of reports reach the team in San Antonio that is compiling the data, so the trends could change, Holcomb said.
Holcomb also stressed that the registry includes only inpatient data. Of all troops injured in the war zones, he estimates that half receive outpatient care and return to duty.
The data analyzed so far show that 39 percent of the injuries of hospitalized troops in Southwest and Central Asia are from penetrating trauma, and about 25 percent are due to injuries from roadside bombs and other explosive ordnance.
These two types of injuries, which are also the leading cause of deaths among combat troops, often occur in tandem. They account for nearly 88 percent of battle injuries and about 27 percent of nonbattle injuries.
Nearly half of the wounded have multiple injuries. Meanwhile, for those who suffer trauma to only one part of the body, almost 35 percent had wounds to their arms or legs and just over 11 percent had head and/or neck injuries.
Only 4.4 percent of traumatic wounds were to the torso — an indication that body armor may be helping limit damage for troops hit in that area.
Trauma patients in Iraq and Afghanistan who are injured badly enough to be hospitalized are evacuated out of the combat support hospitals in theater nearly three-fourths of the time; fewer than 20 percent return to duty directly from those facilities.
Of all the trauma patients who are flown to Landstuhl from the combat support hospitals, about 77 percent are then evacuated back to the States for further care. Only about 10 percent of the Landstuhl trauma inpatients return from there to the war zones, the data show.
Regardless of where they are ultimately evacuated for care, however, most of the injured can return to duty at some point, Holcomb said.
Such trauma registries — which are well proven in civilian hospitals — are the backbone of medical trauma systems, which improve chances of survival, reduce the days in intensive care and the overall days spent in the hospital.
A learning process
The military, however, has not had to use such a system since Vietnam and is just now getting back up to speed.
Capturing military trauma data “was just amazingly well done” during the Vietnam War, said Ellen Embrey, deputy assistant secretary of defense for force health protection and readiness. “Since that time, because we haven’t had many opportunities to capture that kind of thing, we sort of got rusty at it.”
Embrey said the need to reinstitute a new trauma registry, “to make sure we were capturing the same kind of data across the services,” became evident with the advent two years ago of the intense, large-scale war in Iraq.
The joint theater trauma program is an effort to bring the services’ information together.
Holcomb said he doesn’t expect the data being collected to differ much from what was seen in the Vietnam War, although the widespread use of protective chest plates will probably decrease wounds and deaths from chest injuries, which is what military officials saw in Somalia in the early 1990s, in a very small sample.
Medical officials have been meeting weekly to improve the registry, with strong support from the Pentagon’s Office of Health Affairs and the services’ surgeons general.
They hope to perform a comparative analysis with other conflicts, enabling them to see over time how the enemy’s tactics have changed, so the military can better prevent injuries and better treat those that do occur.
“You’ve got to know what’s happening so you can prevent it,” Holcomb said.