ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
Outcomes following implementation of a structured diagnostic and treatment approach for combat abdominal trauma in a hybrid war setting: a retrospective cohort study.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study evaluated whether implementation of an optimized diagnostic and treatment protocol improved early and intermediate outcomes among combat casualties.
backgroundHigh-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.
methodsA 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.
resultsAfter 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).
conclusionsImplementation 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.
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