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Died of wounds: a mortality review
  1. Damian Douglas Keene1,
  2. JG Penn-Barwell2,
  3. PR Wood1,3,
  4. N Hunt4,
  5. R Delaney5,
  6. J Clasper6,
  7. RJ Russell7 and
  8. PF Mahoney1,6
  1. 1Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2Institute of Naval Medicine, Gosport, UK
  3. 3Department of Anaesthesia, Queen Elizabeth Hospital, Birmingham, UK
  4. 4Forensic Pathology Services Wantage, Oxon, UK
  5. 5South West Group Practice, Bristol, UK
  6. 6Centre for Blast Injury Studies, Imperial College, London, UK
  7. 7Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Maj Damian Douglas Keene, Academic Department of Military Anaesthesia and Critical Care, Institute of Research and Development, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK; Damian.keene{at}


Objectives Combat casualty care is a complex system involving multiple clinicians, medical interventions and casualty transfers. Improving the performance of this system requires examination of potential weaknesses. This study reviewed the cause and timing of death of casualties deemed to have died from their injuries after arriving at a medical treatment facility during the recent conflicts in Iraq and Afghanistan, in order to identify potential areas for improving outcomes.

Methods This was a retrospective review of all casualties who reached medical treatment facilities alive, but subsequently died from injuries sustained during combat operations in Afghanistan and Iraq. It included all deaths from start to completion of combat operations. The UK military joint theatre trauma registry was used to identify cases, and further data were collected from clinical notes, postmortem records and coroner's reports.

Results There were 71 combat-related fatalities who survived to a medical treatment facility; 17 (24%) in Iraq and 54 (76%) in Afghanistan. Thirty eight (54%) died within the first 24 h. Thirty-three (47%) casualties died from isolated head injuries, a further 13 (18%) had unsurvivable head injuries but not in isolation. Haemorrhage following severe lower limb trauma, often in conjunction with abdominal and pelvic injuries, was the cause of a further 15 (21%) deaths.

Conclusions Severe head injury was the most common cause of death. Irrespective of available medical treatment, none of this group had salvageable injuries. Future emphasis should be placed in preventative strategies to protect the head against battlefield trauma.

  • military
  • United Kingdom
  • Cause of Death
  • Afghan Campaign 2001
  • Iraq War 2003-2011

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