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Ten-year reduction in thoracic injury-related mortality among Israel Defense Forces soldiers
  1. Jacob Chen1,2,3,
  2. A M Tsur1,3,4,
  3. R Nadler1,3,5,
  4. E Beit Ner3,6,
  5. A Sorkin1,
  6. I Radomislensky1,7,
  7. K Peleg3,7,
  8. R Ben Avi8,
  9. G Shushan9,
  10. E Glassberg1,10 and
  11. A Benov1,10
  1. 1Medical Corps, Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel
  2. 2Hospital Management, Meir Medical Center, Kefar Saba, Israel
  3. 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  4. 4Department of Medicine B, Zabludowicz Center for Autoimmune Diseases Israel, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
  5. 5General Surgery B, Sheba Medical Center, Ramat Gan, Israel
  6. 6Orthopedic, Shamir Medical Center, Zerifin, Israel
  7. 7Gertner Institute for Health Policy and Epidemiology, Tel HaShomer, Israel
  8. 8Cardiovascular Department and Research Center, Poriya Medical Center, Tiberias, Israel
  9. 9Ground Forces Technology Unit, Tel Hashomer, Israel Defense Forces, Ramat Gan, Israel
  10. 10The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
  1. Correspondence to Dr Jacob Chen, Medical Corps, Surgeon General’s Headquarters, Israel Defense Forces, Ramat Gan, Israel; jacopo669{at}gmail.com

Abstract

Introduction This study aims to describe injury patterns, prehospital interventions and mortality rates of combat-related thoracic injuries during the past decade among Israel Defense Forces (IDF) soldiers before and after implementation of the 2012 IDF-Military Corps ‘My Brother’s Keeper’ plan which included the publication of clinical practice guidelines (CPGs) for thoracic injuries, emphasis on adequate torso protection, introduction of modern life-saving procedures and encouragement of rapid evacuation.

Methods The IDF prehospital trauma registry was reviewed to identify all patients who sustained thoracic injuries from January 2006 to December 2017. IDF soldiers who were injured, died of wounds or killed in action (KIA) were included. These were cross-referenced with the Israel National Trauma Registry. The periods before and after the plan were compared.

Results 458 (12.3%) of 3733 IDF soldiers wounded on the battlefield sustained combat-related thoracic injuries. The overall mortality was 44.3% before the CPG and 17.3% after (p<0.001). Most were KIA: 97% (95 of 98) died by 30 June 2012, and 83% (20 of 24) after (p<0.001). Casualties treated with needle thoracostomy before and after CPG were 6.3% and 18.3%, respectively (p=0.002). More tube thoracostomies were performed after June 2012 (16.1% vs 5.4%, p=0.001). Evacuation was faster after June 2012 (119.4 min vs 560.8 min, p<0.001), but the rates of casualties evacuated within 60 min were similar (21.1% vs 25%, p=0.617).

Conclusions Among military casualties with thoracic injuries, the rate of life-saving interventions increased, evacuation time decreased and mortality dropped following the implementation of My Brother’s Keeper plan.

  • thoracic surgery
  • surgery
  • adult intensive & critical care

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • JC and AMT are joint first authors.

  • Contributors JC conducted the literature search, designed the study, analysed and interpreted the data, drafted the manuscript, and critically revised and approved the final version. AMT and RN collected the data, designed the study, advised on methods, analysed and interpreted the data, and critically revised and approved the final version. EBN, IR, KP, GS, EG and AB advised on methods, analysed the data, and critically revised and approved the final version. JC and AB (guarantors) accept full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.