Page 21 - JSOM Winter 2022

Data Acquisition group of 28,222 subjects, we identified 136 (0.5%) casualties
We conducted a retrospective review of prospectively collected with serious or worse facial trauma, of whom 4 (0.01% of to-
data within the DoDTR. We queried the DoDTR using a series tal dataset) had isolated injury to the face. Of note, there were
of emergency department (ED) procedure codes to acquire the no casualties with an AIS of 5 or 6 for the facial body region
subjects which is previously described. We then searched for (Figure 1). Of subjects with serious facial trauma, the median
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all casualties with an abbreviated injury scale (AIS) score of 3 age was 25 (IQR 21–30), the median injury severity score (ISS)
(serious) or greater to the face to define the baseline popula- was 27 (IQR 19–35), most were male (99.2%). Additionally,
tion (Table 1). Within that population, we searched for all the US military made up the greatest proportion (37.5%), most
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airway interventions. were injured by explosives (59.5%), most were in Afghanistan
(65.4%), and most survived to hospital discharge (87.5%).
TABLE 1 Description of the Abbreviated Injury Scale (AIS) Scoring
System 25–27
FIGURE 1 Breakdown of abbreviated injury scales values for the
Estimated facial body region for entire dataset.*
AIS Score Categorization Example Mortalit, % AIS Score Percentage n
1 Minor Superficial laceration 0 0 74.0 20,897
2 Moderate Fractured sternum 1–2
1 12.3 3,459
3 Serious Open fracture of the 8–10 2 13.2 3,730
humerus
3 <0.5 120
4 Severe Perforated trachea 5–50
5 Critical Ruptured liver with 5–50 4 <0.01 16
tissue loss 5 0 0
6 Maximum Total severance of 100 6 0 0
aorta Total 100
*For the facial body region, there were no casualties with an AIS of
DoDTR Description 5 or 6.
The DoDTR, formerly known as the Joint Theater Trauma
Registry (JTTR), is the data repository for DoD trauma- Of this serious facial trauma cohort, 19 had documentation of
related injuries. 19,21–24 The DoDTR includes documentation re- an airway intervention (13.9%). The median age was 26 (IQR
garding demographics, injury-producing incidents, diagnoses, 21–29), the median ISS was 34 (IQR 27-41), all were male, the
treatments, and outcomes of injuries sustained by US military US military made up the greatest proportion (36.8%), most
and US civilian personnel in wartime and peacetime from the were injured by explosive (63.1%), most were in Afghanistan
point of injury to final disposition. Short-term outcome data (84.2%), and most survived to hospital discharge (57.8%,
are available for non-US casualties. The DoDTR comprises all Table 2). Within the overall dataset (n= 28,222), no casualties
patients admitted to a Role 3 (fixed-facility) or forward surgi- with serious facial trauma underwent NPA placement, 0.04%
cal team (FST) with an injury diagnosis using the International underwent cricothyrotomy (n = 10), 0.03% underwent intu-
Classification of Diseases 9th Edition (ICD-9) between 800– bation (n = 9), and a single subject underwent SGA placement
959.9, near-drowning/drowning with associated injury (ICD-9 (<0.01%). Among subjects with serious injury to the face, the
994.1) or inhalational injury (ICD-9 987.9) and trauma oc- incidence of NPA placement was 0%, cricothyrotomy was
curring within 72 hours from injury. The registry defines the 7.3%, intubation was 6.6%, and SGA was 0.7% (Table 3).
prehospital setting as any location prior to reaching a location
with surgical capabilities or a combat support hospital (CSH) Discussion
to include the Role 1 (point of injury, casualty collection point,
battalion aid station) and Role 2 (temporary limited- capability In our study, we present the incidence of airway interventions
forward-positioned hospital inside combat zone without sur- in a unique subset of the population with serious facial trauma.
gical support). 10,19,23,24 The Joint Trauma System (JTS) has Overall, we found that the incidence of serious injury to face
trained staff that perform the scoring of the abbreviated injury was rare (0.5%; 136 of 28,222). Correspondingly, we also
scale and the composite injury score to ensure standardization. found that the incidence of serious facial injury with airway
intervention was rare (0.07%; 19 of 28,222). Cricothyrotomy
Analysis was rarely performed in the prehospital setting in patients with
We performed all statistical analysis using Microsoft Excel ver- serious facial trauma (0.04%; 10 of 28,222). As our original
sion 10 (Microsoft, www.microsoft.com/en-us/microsoft-365/ dataset was aimed at describing ED interventions performed
excel) and JMP Statistical Discovery version 13 (SAS, https:// in casualties, we used a very broad set of procedure codes to
www.jmp.com/en_us/home.html). We reported categorical vari- capture casualties that required any level of trauma-relevant
ables as numbers with percentages, ordinal variables as medians interventions. With the broad search criteria used for the
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with interquartile ranges, and continuous variables as means original dataset, it is unlikely that we missed few, if any, trau-
with standard deviation. We defined an isolated injury to the ma-relevant interventions among the 38,769 total casualties in
face as an AIS of 3 or greater for the facial body region and AIS the DoDTR during our search period. Extrapolating the data
of 0 for all other body regions (Table 1). to the entire DoDTR population within the time span that we
searched using the procedure codes (e.g., including casualties
Results not captured by our search criteria, airway interventions in ca-
sualties with serious facial injuries would have an incidence of
From January 2007 to August 2016, there were a total of 0.05%). Put another way, for every 10,000 casualty encoun-
38,769 encounters in the DoDTR. Our predefined search ters, only five would have an airway intervention performed in
codes captured 28,222 (72.8%) of those subjects. Within that the setting of serious injury to the face.

Airway in Facial Trauma | 19