Murray Clinton K, Wilkins Kenneth, Molter Nancy C, Li Fang, Yu Lily, Spott Mary Ann, Eastridge Brian, Blackbourne Lorne H, Hospenthal Duane R
Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA.
J Trauma. 2011 Jul;71(1 Suppl):S62-73. doi: 10.1097/TA.0b013e3182218c99.
Continued assessment of casualty complications, such as infections, enables the development of evidence-based guidelines to mitigate excess morbidity and mortality. We examine the Joint Theater Trauma Registry (JTTR) for infections and potential risk factors, such as transfusions, among Iraq and Afghanistan trauma patients.
JTTR entries from deployment-related injuries with completed records between March 19, 2003, and April 13, 2009, were evaluated using International Classification of Diseases-9 codes for infections defined by anatomic/clinical syndromes and/or type of infecting organisms. Risk factors included mechanisms of injury, patient demographics, Injury Severity Score (ISS), and transfusion, including massive transfusions (≥ 10 units of packed red blood cells).
We reviewed 16,742 patients entries (15,021 from Operation Iraqi Freedom (9,883 battle injuries [BI]) and 1,721 from Operation Enduring Freedom (1,090 BI). A total of 96.6% were men and 77.6% were Army personnel. The majority of BI were due to explosive devices (36.3%). There were 921 patients (5.5%) who had one or more infection codes with only 111 (0.6%) recorded deaths (16 with infections). Infections were commonly gram-negative bacteria (47.6%) involving skin/wound infections (26.7%), and lung infections (14.6%). Risk factors or associations that were most notable in univariate and multivariate analysis were calendar year of trauma, ISS, and pattern of injury.
The 5.5% infection rate is consistent with previous military and civilian trauma literature; however, with the limitations of the JTTR, the infection rate is likely an underrepresentation due to inadequate level V and long-term infectious complications data. Combat operational trauma is primarily associated with gram-negative bacteria typically involving infections of wounds or other skin structures and lung infections such as pneumonia. They are commonly linked with higher ISS and injuries to the head, neck, and face.
持续评估伤员并发症，如感染情况，有助于制定循证指南以降低过高的发病率和死亡率。我们研究了联合战区创伤登记处（JTTR）中伊拉克和阿富汗创伤患者的感染情况及潜在风险因素，如输血情况。
使用国际疾病分类第9版编码，依据解剖/临床综合征和/或感染病原体类型来定义感染，对2003年3月19日至2009年4月13日期间有完整记录的与部署相关损伤的JTTR条目进行评估。风险因素包括损伤机制、患者人口统计学特征、损伤严重程度评分（ISS）以及输血情况，包括大量输血（≥10单位浓缩红细胞）。
我们审查了16742例患者条目（15021例来自伊拉克自由行动（9883例战斗损伤[BI]），1721例来自持久自由行动（1090例BI））。其中96.6%为男性，77.6%为陆军人员。大多数战斗损伤是由爆炸装置导致的（36.3%）。有921例患者（5.5%）有一个或多个感染编码，仅有111例（0.6%）记录死亡（16例死于感染）。感染常见为革兰氏阴性菌（47.6%），涉及皮肤/伤口感染（26.7%）和肺部感染（14.6%）。单因素和多因素分析中最显著的风险因素或关联因素为创伤发生年份、ISS以及损伤类型。
5.5%的感染率与先前的军事和民用创伤文献一致；然而，由于JTTR存在局限性，由于V级数据不足以及长期感染并发症数据缺失，感染率可能被低估。战斗行动创伤主要与革兰氏阴性菌相关，通常涉及伤口或其他皮肤结构感染以及肺部感染如肺炎。这些感染通常与较高的ISS以及头部、颈部和面部损伤有关。
