Jornal de Trauma e Tratamento

Effects of Prehospital Wound Prophylaxis in Iraq and Afghanistan on Mortality

Abstract

Jason F Naylor*, Kimberly Burbank, Michael D April, Joseph C Wenke, Joseph K Maddry and Steven G Schauer

Introduction: A significant proportion of traumatic injuries sustained during the recent conflicts in Afghanistan and Iraq developed subsequent wound infections. Previous studies demonstrate lower infectious rates with timely administration of antibiotics, but do not evaluate impact on mortality. We compare demographics, injury characteristics, and survival rates among adult combat casualties receiving prehospital wound prophylaxis versus casualties not receiving antibiotic prophylaxis.
Methods: We used a series of emergency department (ED) procedure codes to identify subjects within the Department of Defense Trauma Registry (DODTR) from January 2007 to August 2016. We included subjects that sustained a gunshot wound (GSW), traumatic amputation, or open-fracture proximal to the digits. We stratified our comparisons of characteristics between casualties receiving antibiotic prophylaxis to those not receiving antibiotic prophylaxis by specific injury pattern.
Results: During the study period, our predefined ED search codes captured 28222 of the total 38769 subjects encountered in the DODTR. We identified 6662 subjects with a GSW, 1899 subjects with an amputation, and 6553 subjects with an open fracture. Among subjects with these injuries, 9.8% (1483 of 15114) received prehospital wound prophylaxis. There was no difference in survival to discharge rates between casualties that received prehospital wound prophylaxis and those that did not among subjects who sustained amputations (93.9% vs. 90.7%, p=0.271) or open fractures (96.8% versus 95.9%, p=0.368). In the GSW group, subjects that received antibiotics had a significantly higher survival rate compared to subjects that did not receive prehospital wound prophylaxis (96.2% versus 92.8%, p<0.001). This association persisted on multivariable regression analysis (OR 1.61, 95% CI 1.09-2.38).
Conclusion: Military prehospital providers infrequently administered wound prophylaxis during the recent conflicts in Afghanistan and Iraq. There is an association between prehospital administration of antibiotics and increased survival among casualties suffering gunshot wounds.