Impact of explosive devices in modern armed conflicts: In-depth analysis of dutch battle casualties in southern afghanistan

Background: The patterns and mechanisms of injuries of all Dutch battle casualties (BCs) were analyzed to improve the care for injured service members. We performed an in-depth analysis of all Dutch BCs during the participation of The Netherlands as lead nation in the International Security Assistance Force mission in southern Afghanistan. Methods: Participants were selected from the trauma registry at the Dutch Role 2 Medical Treatment Facility if they met the criteria for Dutch BC between August 2006 and August 2010. Results: The trauma registry query resulted in 199 Dutch BCs. The battle injuries were predominantly caused by explosions (83.9 %). The case-fatality rate was 9.5 %: 16.5 % were killed in action, and 1.1 % died of wounds. The wounding pattern was as follows: head and neck (32.2 %), thorax (7.8 %), abdomen (12.7 %), upper extremity (17.6 %), lower extremity (29.7 %). The mean Abbreviated Injury Scale and Injury Severity Score were 3 (range 0-5) and 11 (range 1-43), respectively in the wounded-in-action group. Conclusions: Explosive devices accounted for almost 85 % of the casualties - much higher than in previous wars. Knowledge of the management of these injuries is also valuable in treating casualties from natural disasters or (terrorist) mass casualty situations. An integral multinational joint approach is highly recommended to develop more effective protective equipment and body armor. Prospective registration in a standardized system of data collection that encompasses all echelons of the medical support organization should be implemented.