United States Army Institute of Surgical Research, Ft. Sam Houston, TX, USA.
Am J Surg. 2009 Dec;198(6):852-7. doi: 10.1016/j.amjsurg.2009.04.029.
The US military forces developed and implemented the Joint Theater Trauma System (JTTS) and Joint Theater Trauma Registry (JTTR) using US civilian trauma system models with the intent of improving outcomes after battlefield injury.
The purpose of this analysis was to elaborate the impact of the JTTS. To quantify these achievements, the JTTR captured mechanism, acute physiology, diagnostic, therapeutic, and outcome data on 23,250 injured patients admitted to deployed US military treatment facilities from July 2003 through July 2008 for analysis. Comparative analysis to civilian trauma systems was done using the National Trauma Data Bank (NTDB).
In contrast to civilian trauma systems with an 11.1% rate of penetrating injury, 68.3% of battlefield wounds were by penetrating mechanism. In the analyzed cohort, 23.3% of all patients had an Injury Severe Score (ISS) > or = 16, which is similar to the civilian rate of 22.4%. In the military injury population, 66% of injuries were combat-related. In addition, in the military injury group, 21.8% had metabolic evidence of shock with a base deficit > or = 5, 29.8% of patients required blood transfusion, and 6.4% of the total population of combat casualties required massive transfusion (>10 U red blood cells/24 hours). With this complex and severely injured population of battlefield injuries, the JTTS elements were used to recognize and remedy more than 60 trauma system issues requiring leadership and advocacy, education, research, and alterations in clinical care. Of particular importance to the trauma system was the implementation and tracking of performance improvement indicators and the dissemination of 27 evidence-based clinical practice guidelines (CPGs). In particular, the damage control resuscitation guideline was associated with a decrease in mortality in the massively transfused from 32% pre-CPG to 21% post-CPG. As evidence of the effectiveness of the JTTS, a mortality rate of 5.2% after battlefield hospital admission is comparable to a case fatality rate of 4.3% reported in an age-matched cohort from the NTDB.
JTTS initiatives contributed to improved survival after battlefield injury. The JTTS has set the standard of trauma care for the modern battlefield using contemporary systems-based methodologies.
美国军方利用美国民用创伤系统模型开发并实施了联合战区创伤系统（JTTS）和联合战区创伤登记处（JTTR），旨在改善战场损伤后的结局。
本分析旨在阐述 JTTS 的影响。为了量化这些成就，JTTR 收集了 2003 年 7 月至 2008 年 7 月期间部署到美军治疗设施的 23250 名受伤患者的机制、急性生理学、诊断、治疗和结局数据进行分析。使用国家创伤数据库（NTDB）进行了与民用创伤系统的比较分析。
与穿透伤率为 11.1%的民用创伤系统相比，68.3%的战场伤口为穿透伤机制。在分析的队列中，所有患者中有 23.3%的创伤严重评分（ISS）≥16，这与民用创伤系统的 22.4%相似。在军事损伤人群中，66%的损伤与战斗有关。此外，在军事损伤组中，21.8%的患者有代谢性休克证据，碱缺失≥5，29.8%的患者需要输血，总战斗伤亡人群中有 6.4%需要大量输血（＞10U 红细胞/24 小时）。对于这种复杂且严重的战场损伤人群，JTTS 要素用于识别和纠正需要领导和倡导、教育、研究以及改变临床护理的 60 多个创伤系统问题。对创伤系统特别重要的是实施和跟踪绩效改进指标以及传播 27 项基于证据的临床实践指南（CPG）。特别是，损伤控制复苏指南与大量输血患者死亡率的降低有关，从 CPG 前的 32%降至 CPG 后的 21%。作为 JTTS 有效性的证据，战场医院入院后的死亡率为 5.2%，与 NTDB 中年龄匹配队列报告的病死率 4.3%相当。
JTTS 计划有助于改善战场损伤后的生存。JTTS 利用现代基于系统的方法为现代战场制定了创伤护理标准。
