The burden of gunshot wounding of UK military personnel in Iraq and Afghanistan from 2003–14

• Published in: Injury 2018-06, Vol.49 (6), p.1064-1069
• Main Authors: Stevenson, T., Carr, D.J., Penn-Barwell, J.G., Ringrose, T.J., Stapley, S.A.
• Format: Article
• Language: English
• Subjects: Adult; Afghan Campaign 2001; Amputation, Traumatic - epidemiology; Ballistic; Critical Care; Epidemiology; Female; Gunshot; Humans; Iraq War, 2003-2011; Length of Stay - statistics & numerical data; Male; Middle Aged; Military; Military Medicine; Military Personnel - statistics & numerical data; Registries; Retrospective Studies; Trauma Severity Indices; United Kingdom - epidemiology; Wounding; Wounds, Gunshot - epidemiology; Wounds, Gunshot - therapy; Young Adult
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2018.03.028

Gunshot wounding (GSW) is the second most common mechanism of injury in warfare after explosive injury. The aim of this study was to define the clinical burden of GSW placed on UK forces throughout the recent Iraq and Afghanistan conflicts. This study was a retrospective review of data from the UK Military Joint Theatre Trauma Registry (JTTR). A JTTR search identified records within the 12 year period of conflict between 19 Mar 2003 and 27 Oct 2014 of all UK military GSW casualties sustained during the complete timelines of both conflicts. Included cases had their clinical timelines and treatment further examined from time of injury up until discharge from hospital or death. There were 723 casualties identified (177 fatalities, 546 survivors). Median age at the time of injury was 24 years (range 18–46 years), with 99.6% of casualties being male. Most common anatomical locations for injury were the extremities, with 52% of all casualties sustaining extremity GSW, followed by 16% GSW to the head, 15% to the thorax, and 7% to the abdomen. In survivors, the rate of extremity injury was higher at 69%, with head, thorax and abdomen injuries relatively lower at 5%, 11% and 6% respectively. All GSW casualties had a total of 2827 separate injuries catalogued. A total of 545 casualties (523 survivors, 22 fatalities) underwent 2357 recorded surgical procedures, which were carried out over 1455 surgical episodes between admission to a deployed medical facility and subsequent transfer to the Royal Centre for Defence Medicine (RCDM) in the UK. This gave a median of 3 (IQR 2–5) surgical procedures within a median of 2 (IQR 2–3) surgical episodes per casualty. Casualties had a combined length of stay (LoS) of 25 years within a medical facility, with a mean LoS in a deployed facility of 1.9 days and 14 days in RCDM. These findings define the massive burden of injury associated with battlefield GSW and underscore the need for further research to both reduce wound incidence and severity of these complex injuries.