Comparison Between Civilian Burns and Combat Burns From Operation Iraqi Freedom and Operation Enduring Freedom

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Abstract
To assess outcome differences between locally burned civilians and military personnel burned in a distant combat zone treated in the same facility. The United States Army Institute of Surgical Research (USAISR) Burn Center serves as a referral center for civilians and is the sole center for significant burns in military personnel. We made the hypothesis that outcomes for military personnel burned in the current conflict in Iraq and Afghanistan would be poorer because of delays to definitive treatment, other associated injury, and distance of evacuation. We reviewed the civilian and military records of patients treated at the USAISR from the outset of hostilities in Iraq in April 2003 to May 2005. Demographics, injury data, mortality, and clinical outcomes were compared. We cared for 751 patients during this time period, 273 of whom were military (36%). Military injuries occurred in a younger population (41 ± 19 vs. 26 ± 7 years for civilian and military respectively, P < 0.0001) with a longer time from injury to burn center arrival (1 ± 5 days vs. 6 ± 5, P < 0.0001), a higher Injury Severity Score (ISS 5 ± 8 vs. 9 ± 11, P < 0.0001), and a higher incidence of inhalation injury (8% vs. 13%, P = 0.024). Total burn size did not differ. Mortality was 7.1% in the civilian and 3.8% in the military group (P = 0.076). When civilians outside the age range of the military cohort were excluded, civilian mortality was 5.0%, which did not differ from the military group (P = 0.57). Total body surface area (TBSA) burned, age ≥40 years, presence of inhalation injury, and ventilator days were found to be important predictors of mortality by stepwise regression, and were used in a final predictive model with the area under receiver operator characteristic curve of 0.97 for both populations considered together. No significant effect of either group was identified during development. Mortality does not differ between civilians evacuated locally and military personnel injured in distant austere environments treated at the same center.

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