Improvised explosive devices and mines pose a formidable threat to military convoys traveling in Iraq. This study evaluated battle injuries sustained by a mechanized battalion operating against this threat. The objective was to gain insight into injury profiles and prevention. In the period examined, 32 attacks injured 120 Marines, causing 188 injuries. Upper extremity and head injuries (70%) were common, whereas lower extremity injuries (11%) were rare (as expected, given the threat and the body areas exposed). Shoulder and axilla protectors may be beneficial, but lower arm and hand injuries remain difficult to combat. Ear injury was the most common single injury type (23%). Combat earplugs may reduce ear blast injuries. Eye injuries were uncommon (0.5%), likely because of ballistic eye protection. Injury to the torso (11%) was generally mild, because of body armor vests. The majority of wounds were minor, allowing > 80% of the injured Marines to return to duty.
"This is especially true for routine procedures such as hearing screening or monitoring for hearing change caused by ototoxic agents and excessive noise exposure. Injuries to the ear are one of the most common, single injury types among soldiers (Gondusky and Reiter, 2005). Auditory impairment and tinnitus represent the most prevalent service-connected disabilities, resulting in 1 billion dollars in associated health-care costs. "
[Show abstract][Hide abstract] ABSTRACT: Teleaudiology offers the opportunity of providing health services to remote locations and underserved populations who lack access to audiology personnel and clinical resources. Remote monitoring of hearing is especially important when considering side effects of chemotherapy drugs such as cisplatin, which has the potential to seriously damage a patient’s hearing. A person receiving cisplatin therapy would benefit significantly by having their high frequency hearing tested frequently during therapy; if hearing was found to be impacted, an oncologist and audiologist could be notified and a dosing change or alternative drug option could be considered to avoid long term and profound hearing loss. We have previously reported on the OtoID, which is a device that enables remote monitoring of hearing by a patient during chemotherapy treatment. In this paper, we present results showing how hearing screenings done using the OtoID generally match well when done by a patient compared with when an audiologist performs the test. We show that automated testing by 21 subjects undergoing chemotherapy treatment with cisplatin enabled subjects to use a self-test to detect ASHA-specific changes in hearing with a sensitivity of 80.6% and a specificity of 86.3%. Results suggest that the OtoID may be useful in the future for in-home identification of hearing changes while undergoing ototoxic chemotherapy treatment.
Journal of the American Academy of Audiology 09/2015; DOI:10.3766/jaaa.15028 · 1.58 Impact Factor
"For instance, irritability was not included because it was not used as a clinical diagnosis in VA care during the study period, possibly because clinicians are more likely to include it as a component of another diagnosis. Because of variation in etiology, we divided pain diagnoses into three groups based on relationships to TBI, PTSD, and depression: neck pain, headache, other pain (primarily low back pain, but also includes chronic pain, chronic pain Brain Imaging and Behavior syndrome, central pain, and excludes cancer pain and acute pain) (A.P. Association 2000; Cifu et al. 2014; Gondusky and Michael 2005; Landy 1998; Lew et al. 2009; Murray et al. 2005; Nampiaparampil 2008; Romesser et al. 2012; Uomoto and Esselman 1993; Ruff 2008). Because ICD-9-CM codes are derived from clinical care, they generally represent the primary reason for seeking care at a specific visit. "
[Show abstract][Hide abstract] ABSTRACT: U. S. veterans of Iraq and Afghanistan are known to have a high prevalence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression, which are often comorbid and share many symptoms. Attempts to describe this cohort by single diagnoses have limited our understanding of the complex nature of this population. The objective of this study was to identify subgroups of Iraq and Afghanistan veterans (IAVs) with distinct compositions of symptoms associated with TBI, PTSD, and depression. Our cross-sectional, observational study included 303,716 IAVs who received care in the Veterans Health Administration in 2010-2011. Symptoms and conditions were defined using International Classification of Diseases, Ninth Revision codes and symptom-clusters were identified using latent class analysis. We identified seven classes with distinct symptom compositions. One class had low probability of any condition and low health care utilization (HCU) (48 %). Other classes were characterized by high probabilities of mental health comorbidities (14 %); chronic pain and sleep disturbance (20 %); headaches and memory problems (6 %); and auditory problems (2.5 %). Another class had mental health comorbidities and chronic pain (7 %), and the last had high probabilities of most symptoms examined (3 %). These last two classes had the highest likelihood of TBI, PTSD, and depression and were identified as high healthcare utilizers. There are subgroups of IAVs with distinct clusters of symptom that are meaningfully associated with TBI, PTSD, depression, and HCU. Additional studies examining these veteran subgroups could improve our understanding of this complex comorbid patient population.
Brain Imaging and Behavior 05/2015; DOI:10.1007/s11682-015-9402-8 · 4.60 Impact Factor
"The introduction of individual body armour has resulted in significant reductions in the incidence and severity of wounds sustained by soldiers on combat operations in the modern age          . However there is a constant drive to develop novel methods of providing protection as well as to refine existing designs of body armour . "
[Show abstract][Hide abstract] ABSTRACT: Introduction:
There is a requirement in the Ministry of Defence for an objective method of comparing the area of coverage of different body armour designs for future applications. Existing comparisons derived from surface wound mapping are limited in that they can only demonstrate the skin entry wound location. The Coverage of Armour Tool (COAT) is a novel three-dimensional model capable of comparing the coverage provided by body armour designs, but limited information exists as to which anatomical structures require inclusion. The aim of this study was to assess the utility of COAT, in the assessment of neck protection, using clinically relevant injury data.
Hospital notes and post mortem records of all UK soldiers injured by an explosive fragment to the neck between 01 Jan 2006 and 31 December 2012 from Iraq and Afghanistan were analysed to determine which anatomical structures were responsible for death or functional disability at one year post injury. Using COAT a comparison of three ballistic neck collar designs was undertaken with reference to the percentage of these anatomical structures left exposed.
13/81 (16%) survivors demonstrated complications at one year, most commonly upper limb weakness from brachial plexus injury or a weak voice from laryngeal trauma. In 14/94 (15%) soldiers the neck wound was believed to have been the sole cause of death, primarily from carotid artery damage, spinal cord transection or rupture of the larynx. COAT objectively demonstrated that despite the larger OSPREY collar having almost double the surface area than the two-piece prototype collar, the percentage area of vulnerable cervical structures left exposed only reduced from 16.3% to 14.4%.
COAT demonstrated its ability to objectively quantify the potential effectiveness of different body armour designs in providing coverage of vulnerable anatomical structures from different shot line orientations. To improve its utility, it is recommended that COAT be further developed to enable weapon and tissue specific information to be modelled, and that clinically significant injuries to other body regions are also incorporated.
British Journal of Oral and Maxillofacial Surgery 10/2014; 52(8):e125. DOI:10.1016/j.bjoms.2014.07.247 · 1.08 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.