对美国国防部联合创伤系统院前创伤登记处数据的描述性分析。

A descriptive analysis of data from the Department of Defense Joint Trauma System Prehospital Trauma Registry.

作者信息

Schauer Steven G, April Michael D, Naylor Jason F, Oliver Joshua J, Cunningham Cord W, Fisher Andrew D, Kotwal Russ S

机构信息

USAF En Route Care Research Center, Joint Base San Antonio-Fort Sam Houston, Texas.

出版信息

US Army Med Dep J. 2017 Oct-Dec(3-17):92-97.

PMID:29214626

Abstract

UNLABELLED

The active battlefield is an environment of chaos and confusion. Depending on the scale of combat, the chaos and confusion often extend into the prehospital combat setting with multiple personnel and units involved in the chain of care of casualties. The chaos of the prehospital combat setting has led to limitations in the availability of data for performance improvement and research. The Department of Defense (DoD) Joint Trauma System (JTS) Prehospital Trauma Registry (PHTR) was developed in conjunction with the updated Tactical Combat Casualty Care (TCCC) card and a TCCC after action report (AAR), and currently serves as the prehospital repository and module of the DoD Trauma Registry (DoDTR). We conducted a descriptive analysis of data from the DoDTR PHTR.

METHODS

The JTS collected trauma-associated data which comprise the PHTR are consolidated from TCCC cards and TCCC AARs. Where possible (requires 2 patient identifiers), JTS linked data from the PHTR module to other modules in the DoDTR to maximize availability of prehospital data and gain additional information regarding clinical outcomes.

RESULTS

From January 2013 through September 2014, there were 705 patients available for research, of which 94.8% (668/705) had data from TCCC AARs, 3.3% (23/705) had data from TCCC cards, and 2.0% (14/705) had data available from DoDTR collection forms. There were one or more of the following data points per subject: pulse rate (77.4%, n=546), blood pressure (75.9%, n=535), respiratory rate (76.5%, n=539), pulse oximetry (61.8%, n=436), mental status (96.0%, n=677) and pain score (24.5%, n=173). Only 42.4% (647/1,527) of vital sign metrics had an associated time stamp. Documented interventions included limb tourniquets, of which only 27.3% (113/414) had an associated documentation of application time. Only 27.0% (190/705) of patients in the PHTR could be linked to the DoDTR due to missing identifiers.

CONCLUSIONS

The PHTR data capture was suboptimal with many patients lacking documentation of vital signs and procedural details. Future efforts to improve prehospital data capture will require ownership and enforcement by unit leadership.

摘要

未标注

活跃的战场是一个混乱无序的环境。根据战斗规模的不同，这种混乱往往会延伸到院前战斗环境中，有多名人员和单位参与伤员的护理链。院前战斗环境的混乱导致了用于绩效改进和研究的数据可用性受到限制。美国国防部（DoD）联合创伤系统（JTS）的院前创伤登记处（PHTR）是与更新后的战术战斗伤员护理（TCCC）卡片及一份TCCC行动后报告（AAR）一同开发的，目前作为国防部创伤登记处（DoDTR）的院前存储库和模块。我们对DoDTR PHTR的数据进行了描述性分析。

方法

JTS收集的与创伤相关的数据（构成PHTR）是从TCCC卡片和TCCC AAR中整合而来的。在可能的情况下（需要两个患者标识符），JTS将PHTR模块中的数据与DoDTR中的其他模块相链接，以最大限度地提高院前数据的可用性，并获取有关临床结果的更多信息。

结果

2013年1月至2014年9月期间，有705名患者可用于研究，其中94.8%（668/705）的数据来自TCCC AAR，3.3%（23/705）的数据来自TCCC卡片，2.0%（14/705）的数据可从DoDTR收集表中获取。每个受试者有以下一个或多个数据点：脉搏率（77.4%，n = 546）、血压（75.9%，n = 535）、呼吸频率（76.5%，n = 539）、脉搏血氧饱和度（61.8%，n = 436）、精神状态（96.0%，n = 677）和疼痛评分（24.5%，n = 173）。只有42.4%（647/1,527）的生命体征指标有相关的时间戳。记录的干预措施包括肢体止血带，其中只有27.3%（113/414）有应用时间的相关记录。由于标识符缺失，PHTR中只有27.0%（190/705）的患者能够与DoDTR相链接。