Battlefield Neck Injuries: Contemporary Insights From the Israeli National Trauma Registry

doi:10.1016/j.acepjo.2025.100211

. 2025 Jun 23;6(4):100211.

doi: 10.1016/j.acepjo.2025.100211. eCollection 2025 Aug.

Battlefield Neck Injuries: Contemporary Insights From the Israeli National Trauma Registry

Nir Tsur^{1

2}, Dean Dudkiewicz^{1

2}, Tomer Talmy^{1

3

4}, Irina Radomislensky^{1

5}, Adi Givon⁵, Eldad Katorza^{5

6

7}; Israel Trauma Group; Gilad Twig^{5

7}, Mor Rittblat^{1

3

8}, Shahar Shapira^{5

7}

Collaborators, Affiliations

Collaborators

Israel Trauma Group:
H Bahouth, M Bala, A Bar, A Braslavsky, D Czeiger, D Fadeev, A L Goldstein, I Grevtsev, G Hirschhorn, I Jeroukhimov, A Kedar, Y Klein, A Korin, B Levit, I Schrier, A D Schwarz, W Shomar, D Soffer, M Weiss, O Yaslowitz, I Zoarets

Affiliations

¹ Israeli Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel.
² Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.
³ Department of Military Medicine and "Tzameret," Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
⁴ Division of Anesthesia, Intensive Care & Pain Management, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
⁵ Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
⁶ Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁷ Arrow Program for Medical Research Education, Sheba Medical Center, Ramat Gan, Israel.
⁸ Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.

PMID: 40641888
PMCID: PMC12242401
DOI: 10.1016/j.acepjo.2025.100211

Battlefield Neck Injuries: Contemporary Insights From the Israeli National Trauma Registry

Nir Tsur et al. J Am Coll Emerg Physicians Open. 2025.

. 2025 Jun 23;6(4):100211.

doi: 10.1016/j.acepjo.2025.100211. eCollection 2025 Aug.

Authors

Collaborators

Israel Trauma Group:
H Bahouth, M Bala, A Bar, A Braslavsky, D Czeiger, D Fadeev, A L Goldstein, I Grevtsev, G Hirschhorn, I Jeroukhimov, A Kedar, Y Klein, A Korin, B Levit, I Schrier, A D Schwarz, W Shomar, D Soffer, M Weiss, O Yaslowitz, I Zoarets

Affiliations

¹ Israeli Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel.
² Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.
³ Department of Military Medicine and "Tzameret," Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
⁴ Division of Anesthesia, Intensive Care & Pain Management, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
⁵ Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
⁶ Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁷ Arrow Program for Medical Research Education, Sheba Medical Center, Ramat Gan, Israel.
⁸ Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.

PMID: 40641888
PMCID: PMC12242401
DOI: 10.1016/j.acepjo.2025.100211

Abstract

Objectives: Neck injuries in warfare are critical due to the concentration of vital structures within a relatively unprotected anatomical region. This study aims to provide a comprehensive analysis of the epidemiology, severity, and outcomes of neck injuries during Military operations under "Operation Swords of War," leveraging data from the Israeli National Trauma Registry.

Methods: Data were retrospectively collected for casualties from October 7, 2023, through December 31, 2023. Injury characteristics, time to surgical exploration, and in-hospital outcomes were analyzed.

Results: A total of 1815 trauma casualties were recorded, with 147 (8.1%) suffering from neck injuries. The majority of these injuries were due to penetrating trauma (89.8%), with a significant number leading to surgical exploration (45.0%). The study highlighted the extensive use of resources for managing these severe injuries, including operating rooms and intensive care units.

Conclusion: The findings underscore the high prevalence and severity of neck injuries in military conflicts and the critical need for rapid assessment and intervention. Comparisons with previous conflicts suggest an improvement in survival rates due to enhanced medical response and triage efficiency. In conclusion, neck injuries remain a significant concern in combat settings, necessitating specialized trauma care and rapid intervention strategies. The results from this study provide vital insights that can help improve trauma care protocols and outcomes in future conflicts.

Keywords: ICU admission and outcomes; combat-related neck trauma; military conflict epidemiology; penetrating injuries; rapid intervention strategies; surgical exploration; trauma registry analysis.

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Conflict of interest statement

All authors have affirmed they have no conflicts of interest to declare.

Figures

**Figure 1**
Divided percentage of time to neck exploration versus other procedures. The graph displays the divided percentage of cases explored over time, segmented into the 2 intervals: 0-3.9 hours, and 4+ hours. Each sky-blue bar represents the percent of explorations completed at the interval.

**Figure 2**
Emergency referral and hospitalization distribution in patients with laryngotracheal injuries. The graph displays the comparative distribution of clinical outcomes between patients with vascular injuries and those without vascular injuries. Each blue bar represents the percentage of patients for each variable, illustrating the referral and hospitalization distribution

**Figure 3**
Emergency referral and hospitalization distribution in patients with vascular injury. The graph displays the comparative distribution of clinical outcomes between patients with laryngotracheal injuries and those without laryngotracheal injuries. Each blue bar represents the percentage of patients for each variable, illustrating the referral and hospitalization distribution.

See this image and copyright information in PMC

References

1. Dobson J.E., Newell M.J., Shepherd J.P. Trends in maxillofacial injuries in war-time (1914-1986) Br J Oral Maxillofac Surg. 1989;27(6):441–450. doi: 10.1016/s0266-4356(89)80001-4. - DOI - PubMed
1. Kosashvili Y., Hiss J., Davidovic N., et al. Influence of personal armor on distribution of entry wounds: lessons learned from urban-setting warfare fatalities. J Trauma. 2005;58(6):1236–1240. doi: 10.1097/01.ta.0000169804.17603.76. - DOI - PubMed
1. Breeze J., Clasper J.C. Ergonomic assessment of future methods of ballistic neck protection. Mil Med. 2013;178(8):899–903. doi: 10.7205/MILMED-D-13-00130. - DOI - PubMed
1. Breeze J., Allanson-Bailey L.S., Hunt N.C., Delaney R.S., Hepper A.E., Clasper J. Mortality and morbidity from combat neck injury. J Trauma Acute Care Surg. 2012;72(4):969–974. doi: 10.1097/TA.0b013e31823e20a0. - DOI - PubMed
1. Xydakis M.S., Fravell M.D., Nasser K.E., Casler J.D. Analysis of battlefield head and neck injuries in Iraq and Afghanistan. Otolaryngol Head Neck Surg. 2005;133(4):497–504. doi: 10.1016/j.otohns.2005.07.003. - DOI - PubMed

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[1] Dobson J.E., Newell M.J., Shepherd J.P. Trends in maxillofacial injuries in war-time (1914-1986) Br J Oral Maxillofac Surg. 1989;27(6):441–450. doi: 10.1016/s0266-4356(89)80001-4. - DOI - PubMed

[2] Dobson J.E., Newell M.J., Shepherd J.P. Trends in maxillofacial injuries in war-time (1914-1986) Br J Oral Maxillofac Surg. 1989;27(6):441–450. doi: 10.1016/s0266-4356(89)80001-4. - DOI - PubMed

[3] Kosashvili Y., Hiss J., Davidovic N., et al. Influence of personal armor on distribution of entry wounds: lessons learned from urban-setting warfare fatalities. J Trauma. 2005;58(6):1236–1240. doi: 10.1097/01.ta.0000169804.17603.76. - DOI - PubMed

[4] Kosashvili Y., Hiss J., Davidovic N., et al. Influence of personal armor on distribution of entry wounds: lessons learned from urban-setting warfare fatalities. J Trauma. 2005;58(6):1236–1240. doi: 10.1097/01.ta.0000169804.17603.76. - DOI - PubMed

[5] Breeze J., Clasper J.C. Ergonomic assessment of future methods of ballistic neck protection. Mil Med. 2013;178(8):899–903. doi: 10.7205/MILMED-D-13-00130. - DOI - PubMed

[6] Breeze J., Clasper J.C. Ergonomic assessment of future methods of ballistic neck protection. Mil Med. 2013;178(8):899–903. doi: 10.7205/MILMED-D-13-00130. - DOI - PubMed

[7] Breeze J., Allanson-Bailey L.S., Hunt N.C., Delaney R.S., Hepper A.E., Clasper J. Mortality and morbidity from combat neck injury. J Trauma Acute Care Surg. 2012;72(4):969–974. doi: 10.1097/TA.0b013e31823e20a0. - DOI - PubMed

[8] Breeze J., Allanson-Bailey L.S., Hunt N.C., Delaney R.S., Hepper A.E., Clasper J. Mortality and morbidity from combat neck injury. J Trauma Acute Care Surg. 2012;72(4):969–974. doi: 10.1097/TA.0b013e31823e20a0. - DOI - PubMed

[9] Xydakis M.S., Fravell M.D., Nasser K.E., Casler J.D. Analysis of battlefield head and neck injuries in Iraq and Afghanistan. Otolaryngol Head Neck Surg. 2005;133(4):497–504. doi: 10.1016/j.otohns.2005.07.003. - DOI - PubMed

[10] Xydakis M.S., Fravell M.D., Nasser K.E., Casler J.D. Analysis of battlefield head and neck injuries in Iraq and Afghanistan. Otolaryngol Head Neck Surg. 2005;133(4):497–504. doi: 10.1016/j.otohns.2005.07.003. - DOI - PubMed

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Battlefield Neck Injuries: Contemporary Insights From the Israeli National Trauma Registry

Collaborators

Affiliations

Battlefield Neck Injuries: Contemporary Insights From the Israeli National Trauma Registry

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

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References

LinkOut - more resources

Full Text Sources