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The probability that a given combat wound is lethal provides a quantitative basis for the assessment of wounds, comparison of body armors, and estimation of medical workload requirements in various military scenarios. The present paper describes a new lethality model for penetrating injuries. The model employs a new injury classification called PEBL. PEBL codes are constructed by appending additional significant digits to the appropriate codes from the Hospital Adaptation of the International Classification of the World Health Organization (H-ICDA Codes), widely used in both civilian and military hospitals for injury classification. PEBL attains greater specificity by providing for injury size, bone injury characteristics, partial organ damage, and distinguishing peripheral blood vessels and nerves. Probability of lethality estimates were obtained for PEBL codes based on computerized wound data available on 3600 combat casualties.

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BACKGROUND: The U.S. military conflicts in Iraq and Afghanistan had the most casualties since Vietnam with more than 53,000 wounded in action. Novel injury mechanisms, such as improvised explosive devices, and higher rates of survivability compared with previous wars led to a new pattern of combat injuries. The purpose of the present study was to use latent class analysis (LCA) to identify combat injury profiles among U.S. military personnel who survived serious wounds. METHODS: A total of 5,227 combat casualty events with an Injury Severity Score (ISS) of 9 or greater that occurred in Iraq and Afghanistan from December 2002 to July 2019 were identified from the Expeditionary Medical Encounter Database for analysis. The Barell Injury Diagnosis Matrix was used to classify injuries into binary variables by site and type of injury. LCA was employed to identify injury profiles that accounted for co-occurring injuries. Injury profiles were described and compared by demographic, operational, and injury-specific variables. RESULTS: Seven injury profiles were identified and defined as: (1) open wounds (18.8%), (2) Type 1 traumatic brain injury (TBI)/facial injuries (14.2%), (3) disseminated injuries (6.8%), (4) Type 2 TBI (15.4%), (5) lower extremity injuries (19.8%), (6) burns (7.4%), and (7) chest and/or abdominal injuries (17.7%). Profiles differed by service branch, combat location, year of injury, injury mechanism, combat posture at the time of injury, and ISS. CONCLUSION: LCA identified seven distinct and interpretable injury profiles among U.S. military personnel who survived serious combat injuries in Iraq or Afghanistan. These findings may be of interest to military medical planners as resource needs are evaluated and projected for future conflicts, and medical professionals involved in the rehabilitation of wounded service members.