Outcomes following implementation of a structured diagnostic and treatment approach for combat abdominal trauma in a hybrid war setting: a retrospective cohort study.

OBJECTIVE

This study evaluated whether implementation of an optimized diagnostic and treatment protocol improved early and intermediate outcomes among combat casualties.

BACKGROUND

High-energy ballistic and blast mechanisms during the war in Ukraine caused a surge of complex abdominal injuries requiring intensive resource utilization and rapid coordination of surgical, critical care, and evacuation capabilities.

METHODS

A retrospective cohort study was conducted including 496 male soldiers with combat-related abdominal injuries treated at military hospitals from 2014 to 2017. Patients were stratified into pre-implementation (n = 161) and post-implementation (n = 335) groups. The structured protocol included perfusion index-guided triage, expanded use of FAST, diagnostic laparoscopy, and standardized damage control surgery principles. Primary outcomes were postoperative complications, in-hospital mortality, and return-to-duty rates; secondary outcomes included missed intra-abdominal injuries and hospital length of stay.

RESULTS

After protocol implementation, FAST utilization increased (68.1% vs. 19.3%) and diagnostic laparoscopy increased (30.7% vs. 14.9%), while the rate of missed intra-abdominal injuries decreased from 7.5% to 3.6% (p = 0.04). Median decision-to-surgery time shortened by 26 min (p = 0.001). Postoperative complications declined (39.1% vs. 27.8%, p < 0.05), hospital length of stay decreased (41.3 ± 3.3 vs. 33.1 ± 2.5 days, p < 0.05), and return-to-duty improved (65.2% vs. 74.6%, p = 0.03). Abdominal-injury-related mortality decreased (5.6% vs. 3.6%, p < 0.05), whereas overall in-hospital mortality did not differ (6.8% vs. 5.4%, p = 0.66).

CONCLUSIONS

Implementation of a structured diagnostic and treatment protocol integrating PI-guided triage, FAST, and selective diagnostic laparoscopy was associated with fewer missed injuries, fewer complications, shorter hospitalization, and improved return-to-duty. Overall in-hospital mortality did not differ significantly; however, abdominal-injury-related mortality was lower after protocol implementation.