Impact of Injury Type Related to the Severity of Thoracic and Chest Wall Trauma in Deployed Military Soldiers

Introduction There remains a paucity of literature surrounding chest wall injury within military trauma. The purpose of this study was to examine the US Military Trauma database hypothesizing differences in chest wall injury patterns and rates given the different mechanisms of injury within this population. Methods Records of injuries that occurred between 2004 and 2020 from the US Military Trauma database were evaluated. Patients’ injury characteristics were coded based on mechanism of injury (MOI) and injury severity score (ISS). Individuals with secondary injury types (ITs) were coded as combined injuries. Anatomic injuries were also coded. Statistical analysis was performed with SPSSv.30. Results 1173 patients were evaluated whose ages were 18-22 (38.4%), 23-27 (31.5%), 28-32 (15.4%), 33-37 (9.3%), 38-42 (3.4%), and 43-47 (1.9%), 97.8% male, and ISS 25 (IQR 17-35). Battle-related injuries made up 90.6% of injuries and 11.7% died. The primary IT was penetrating (P) (57.7%) followed by blunt (B) (22.1%) and blunt/penetrating (BP) (20.2%). The top 3 MOI were explosive device (65.8%), bullet/firearm (25.2%), and motor vehicle collision (5.4%). There were significantly different incidences of injury to the thorax based on IT: Lung B (25.5%), P (18.0%), and BP (30.4%) ( P < 0.001); Hemothorax B (8.1%), P (14.9%), and BP (3.8%) ( P = 0.002); Pneumothorax B (6.6%), P (7.2%), and BP (15.6%) ( P = 0.005); Hemopneumothorax B (6.6%), P (7.2%),and BP (15.6%) ( P = 0.005); Rib Fracture B (17.4%), P (14.0%), and BP (25.7%) ( P < 0.001); Sternal Fracture B (1.9%), P (0.9%), and BP (3.8%) ( P = 0.011). Conclusions Deployed military personnel experience significantly different rates of thoracic injury comparing B, P, and BP injury types. The high rate of rib fractures in each IT suggests the presence of chest wall injury in this patient population is a marker of high-energy multisystem trauma with the potential for significant associated injuries.