Abstract：
BACKGROUND: Thoracic trauma occurs frequently in combat and is associated with high mortality. Tube thoracostomy (chest tube) is the treatment for pneumothorax resulting from thoracic trauma, but little data exist to characterize combat casualties undergoing this intervention. We sought to describe the incidence of these injuries and procedures to inform training and materiel development priorities.
METHODS: This is a secondary analysis of a Department of Defense Trauma Registry (DoDTR) data set from 2007 to 2020 describing prehospital care within all theaters in the registry. We described all casualties who received a tube thoracostomy within 24 hours of admission to a military treatment facility. Variables described included casualty demographics; abbreviated injury scale (AIS) score by body region, presented as binary serious (=3) or not serious (<3); and prehospital interventions.
RESULTS: The database identified 25,897 casualties, 2,178 (8.4%) of whom received a tube thoracostomy within 24 hours of admission. Of those casualties, the body regions with the highest proportions of common serious injury (AIS >3) were thorax 62% (1,351), extremities 29% (629), abdomen 22% (473), and head/neck 22% (473). Of those casualties, 13% (276) had prehospital needle thoracostomies performed, and 19% (416) had limb tourniquets placed. Most of the patients were male (97%), partner forces members or humanitarian casualties (70%), and survived to discharge (87%).
CONCLUSIONS: Combat casualties with chest trauma often have multiple injuries complicating prehospital and hospital care. Explosions and gunshot wounds are common mechanisms of injury associated with the need for tube thoracostomy, and these interventions are often performed by enlisted medical personnel. Future efforts should be made to provide a correlation between chest interventions and pneumothorax management in prehospital thoracic trauma.
METHODS: This is a secondary analysis of a Department of Defense Trauma Registry (DoDTR) data set from 2007 to 2020 describing prehospital care within all theaters in the registry. We described all casualties who received a tube thoracostomy within 24 hours of admission to a military treatment facility. Variables described included casualty demographics; abbreviated injury scale (AIS) score by body region, presented as binary serious (=3) or not serious (<3); and prehospital interventions.
RESULTS: The database identified 25,897 casualties, 2,178 (8.4%) of whom received a tube thoracostomy within 24 hours of admission. Of those casualties, the body regions with the highest proportions of common serious injury (AIS >3) were thorax 62% (1,351), extremities 29% (629), abdomen 22% (473), and head/neck 22% (473). Of those casualties, 13% (276) had prehospital needle thoracostomies performed, and 19% (416) had limb tourniquets placed. Most of the patients were male (97%), partner forces members or humanitarian casualties (70%), and survived to discharge (87%).
CONCLUSIONS: Combat casualties with chest trauma often have multiple injuries complicating prehospital and hospital care. Explosions and gunshot wounds are common mechanisms of injury associated with the need for tube thoracostomy, and these interventions are often performed by enlisted medical personnel. Future efforts should be made to provide a correlation between chest interventions and pneumothorax management in prehospital thoracic trauma.
摘要：
背景：胸部创伤在战斗中经常发生，并与高死亡率相关。管状胸廓造口术（胸管）是由胸部创伤引起的气胸的治疗方法，但是几乎没有数据来描述经历这种干预的战斗伤亡。我们试图描述这些伤害的发生率和程序，以告知培训和物资发展优先事项。
方法：这是对2007年至2020年国防部创伤登记处（DoDTR）数据集的二次分析，描述了登记处所有剧院的院前护理。我们描述了所有在进入军事治疗机构后24小时内接受管状胸廓造口术的人员伤亡。描述的变量包括伤亡人口统计数据；按身体区域划分的简化伤害量表（AIS）评分，表现为二元严重(=3)或不严重(<3)；和院前干预。
结果：数据库确定了25,897人伤亡，其中2,178人（8.4％）在入院后24小时内接受了胸腔镜造口术。在这些伤亡中，常见严重损伤比例最高(AIS>3)的身体区域为胸部62%(1351)，四肢29%（629），腹部22%（473），和头部/颈部22%（473）。在这些伤亡中，13％（276）进行了院前针胸廓切开术，19％（416）放置了肢体止血带。大部分患者为男性（97%），伙伴部队成员或人道主义伤亡（70％），存活出院（87%）。
结论：胸部创伤的战斗伤亡者往往有多重损伤，使院前和医院护理复杂化。爆炸和枪伤是常见的损伤机制，与需要进行管状胸廓造口术有关，这些干预措施通常由应征入伍的医务人员进行。未来应努力在院前胸部创伤中提供胸部干预和气胸管理之间的相关性。
方法：这是对2007年至2020年国防部创伤登记处（DoDTR）数据集的二次分析，描述了登记处所有剧院的院前护理。我们描述了所有在进入军事治疗机构后24小时内接受管状胸廓造口术的人员伤亡。描述的变量包括伤亡人口统计数据；按身体区域划分的简化伤害量表（AIS）评分，表现为二元严重(=3)或不严重(<3)；和院前干预。
结果：数据库确定了25,897人伤亡，其中2,178人（8.4％）在入院后24小时内接受了胸腔镜造口术。在这些伤亡中，常见严重损伤比例最高(AIS>3)的身体区域为胸部62%(1351)，四肢29%（629），腹部22%（473），和头部/颈部22%（473）。在这些伤亡中，13％（276）进行了院前针胸廓切开术，19％（416）放置了肢体止血带。大部分患者为男性（97%），伙伴部队成员或人道主义伤亡（70％），存活出院（87%）。
结论：胸部创伤的战斗伤亡者往往有多重损伤，使院前和医院护理复杂化。爆炸和枪伤是常见的损伤机制，与需要进行管状胸廓造口术有关，这些干预措施通常由应征入伍的医务人员进行。未来应努力在院前胸部创伤中提供胸部干预和气胸管理之间的相关性。
