Injury patterns in a war zone: A comparative analysis of civilians and military personnel

Modern armed conflicts increasingly affect both civilians and defense forces, resulting in heterogeneous injury patterns driven by diverse mechanisms. Direct comparative data between these populations treated within the same healthcare system remain limited.

To compare injury mechanisms, anatomical injury patterns, injury severity, and early clinical outcomes between civilians and defense forces casualties treated at a single tertiary trauma center during an active conflict.

A retrospective analysis was conducted of all consecutive war-related trauma admissions between October 7, 2023, and January 7, 2024. Demographic data, injury mechanisms, anatomical sites, Injury Severity Score (ISS), emergency interventions, and early outcomes were collected. Percentage-based comparative plots were used to visualize injury mechanism and anatomical site distributions.

The cohort included 192 patients (128 defense forces, 64 civilians). Civilians were older and included more females. Overall injury severity and rates of airway management, ventilatory support, and ICU admission were comparable between groups. Defense forces more frequently required direct transfer from the emergency department to the operating room (28% vs. 14%, p = 0.047). Shrapnel-related injuries were significantly more common among defense forces, whereas acoustic trauma was observed exclusively among civilians (36%, p < 0.001). Injury-mechanism profiles differed between groups, whereas no statistically significant differences were observed in the proportions of patients injured at the individual anatomical site.

Despite similar overall injury severity, civilians and defense forces exhibit distinct injury profiles. Civilians are disproportionately affected by acoustic trauma, highlighting population-specific vulnerabilities with implications for triage, diagnostic evaluation, and trauma system preparedness, especially during mass casualty incidents, when rapid recognition of group-specific injury patterns is essential for appropriate resource prioritization and allocation.