Incidence of Thromboembolic Disease During Military Operations – Results of a 10-Year Review
In contemporary armed conflicts, limb injuries account for more than half of all injuries. In addition to the characteristically high incidence of infectious complications, injuries associated with military medicine also carry a high risk of thromboembolic disease. This is demonstrated by a study assessing the incidence of thromboembolic disease in American soldiers over 10 years of military operations in the Middle East.
Introduction
The frequency and severity of limb injuries in soldiers are primarily influenced by the improved ballistic protection of the torso, which leaves the limbs relatively unprotected against projectile and shrapnel injuries. Limb injuries sustained in combat are characterized by high-energy trauma, high environmental contamination, and simultaneous damage to multiple limb systems, including vessels, nerves, and bones. These injuries are also characterized by a high number of complications, including infections, compartment syndrome, nonunion of fractures, and thromboembolic disease.
Findings from the Retrospective Review
A retrospective review was conducted on members of the United States Army deployed in combat operations from September 2001 to July 2011, during the Operations Enduring Freedom and Iraqi Freedom. Out of a total of 26,634 evaluated patients, 587 (2.2%) developed thromboembolic disease: there were 270 cases of deep vein thrombosis, 228 cases of pulmonary embolism, and 94 cases of deep vein thrombosis combined with pulmonary embolism.
There was an independent association between lower limb amputations and an increased risk of pulmonary embolism (odds ratio [OR] 1.70; 95% confidence interval [CI] 1.07–2.69). Lower limb amputation was performed on 1,003 individuals, of whom 174 (17%) developed thromboembolic disease (75 with deep vein thrombosis, 70 with pulmonary embolism, and 29 with both deep vein thrombosis and pulmonary embolism). Independent risk factors associated with the risk of thromboembolic disease during amputations included multiple amputations (OR 2.00; 95% CI 1.35–3.42) and amputations performed proximal to the knee joint (OR 2.11; 95% CI 1.3–3.32).
Conclusion
Injuries sustained during combat operations are associated with a high risk of thromboembolic disease, with this risk being highest for injuries requiring multiple amputations and amputations proximal to the knee joint.
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Source: Hutchison T. N., Krueger C. A., Berry J. S. et al. Venous thromboembolism during combat operations: a 10-y review. J Surg Res 2014; 187 (2): 625–630, doi: 10.1016/j.jss.2013.11.008.
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