Mortality in female war veterans of operations enduring freedom and Iraqi freedom.

BACKGROUND Combat-wounded service members are surviving battle injuries more than ever. Given different combat roles held by men and women, female service members should survive wounds at an unprecedented rate. QUESTIONS/PURPOSES We determined whether the casualty rates for females differ from their male counterparts and characterized wounds sustained by female casualties. METHODS We calculated the percentage of the 5141 deaths among the 40,531 casualties by gender for those serving in Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) from Defense Manpower Statistics between 2001 and 2009. We searched the Joint Theatre Trauma Registry for female casualties and described their injury characteristics. No matched cohort of male casualties was searched. RESULTS Female veterans comprised 1.9% of all casualties and 2.4% of all deaths. In OIF, the percent death for women was 14.5% (103 deaths) versus 12.0% (4226 deaths) for men. In OEF, the percent death for women was 35.9% (19 deaths) versus 17.0% (793 deaths) for men. Battle-injured females had a greater proportion of facial and external injuries and more severe extremity injuries compared with those nonbattle-injured. CONCLUSIONS The casualty death rate appears higher for women than men although the mechanisms of fatal injuries are not known and may not be comparable. Although facial, external, and extremity injuries were common among battle-injured females, no conclusion can be made as to whether male casualties sustain similar wounding patterns. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.