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. 2024 Dec 18;24(1):231.
doi: 10.1186/s12873-024-01149-w.

Characteristics and survival of hospitalized combat casualties during two major conflicts between Israel and Hamas: 2023 versus 2014

Abebe Tiruneh #  1 , Ari M Lipsky #  2   3 , Gilad Twig  4   5   6 , Adi Givon  7 , Shachar Shapira  8   9   10 , Sharon Goldman  7 , Irina Radomislensky  7 ; Israel Trauma Group; Avi Benov #  11   12 , Eldad Katorza #  7   4   13   14
Collaborators, Affiliations

Characteristics and survival of hospitalized combat casualties during two major conflicts between Israel and Hamas: 2023 versus 2014

Abebe Tiruneh et al. BMC Emerg Med. .

Abstract

Background: In the complex landscape of modern warfare, understanding combat-related injuries leading to hospitalization is crucial for optimizing injury treatment. This study aims to compare combat casualty characteristics and outcomes during the major conflicts between Israel and Hamas in 2023 and 2014 as a basis for understanding the effectiveness of trauma care practices for wounded soldiers.

Methods: A cohort study of soldiers hospitalized due to combat injuries during two major wars between Israel and Hamas in 2023 and 2014, using data from the Israeli National Trauma Registry. This study did not include deaths before hospital arrival or casualties who were discharged from the Emergency Department.

Results: Of the 1,198 study subjects, 67.8% belonged to the 2023 cohort and 32.2% to the 2014 cohort. The percentage of casualties with severe and critical injuries (Injury Severity Score [ISS] 16-75) was higher among the 2023 cohort (18.6% vs. 13.7%, p = 0.036), as was the percentage of casualties with multiple severe injuries (≥ 2 regions with Abbreviated Injury Score ≥ 3: 11.5% vs. 7.5%, p = 0.035) and firearm injuries (19.6% vs. 14.5%, p = 0.081). Injuries to the torso and extremities were more frequent among the 2023 cohort. Among the critically injured casualties (ISS 25-75), the mortality rates were 17.3% vs. 28.6%, respectively, for the 2023 and 2014 cohorts (p = 0.351); adjusted HR (95% CI): 0.56 (0.21-1.49). The 2023 cohort had higher rates for treatment in the trauma bay (61.5% vs. 47.9%, p < 0.001), ICU utilization (admission: 16.3% vs 11.7%, p = 0.036), surgical intervention (51.5% vs. 42.7%, p = 0.005), longer duration from arrival to surgery (median [interquartile range]: 4.6 (1.2-18.5) vs. 2.6 (1.1-10.1) hours, p = 0.037), and longer hospital stays (> 14 days: 15.5% vs. 8.8%, p < 0.001).

Conclusions: Our data demonstrated that more casualties who survived to hospital arrival were severely and multiply injured in the 2023 Israel-Hamas war as compared to the 2014 war. Despite the increased severity, in-hospital survival did not worsen though there was an increase in hospital resource utilization.

Keywords: Combat; Injuries; Interventions; Resource utilization; Soldier; Survival.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The research received the approval of the Sheba Medical Center’s Institutional Review Board (SMC 5138–18). The research is based on anonymous registry; therefore, the need for consent to participate was waived by the Sheba Medical Center’s Institutional Review Board. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Injury characteristics among combat casualties who were injured during the 2023 war versus 2014 war
Fig. 2
Fig. 2
Kaplan–Meier curves and survival table showing the cumulative survival probability among severe and critically injured combat casualties (ISS 25–75) during the 2023 war versus 2014 war
See this image and copyright information in PMC

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