美国在伊拉克军事人员伤亡的院前转运时间、损伤严重程度和输血对其生存率的影响。
The effect of prehospital transport time, injury severity, and blood transfusion on survival of US military casualties in Iraq.
机构信息
From the Department of Defense Joint Trauma System (R.S.K., L.L.F.S., J.C.J., B.W.T., F.K.B., S.A.S., J.M.G., Z.T.S.), United States Army Institute of Surgical Research (J.T.H., J.M.G.), Joint Base San Antonio-Fort Sam Houston, Texas; and Armed Forces Medical Examiner System (E.L.M.), Dover Air Force Base, Dover, Delaware.
出版信息
J Trauma Acute Care Surg. 2018 Jul;85(1S Suppl 2):S112-S121. doi: 10.1097/TA.0000000000001798.
BACKGROUND
Reducing time from injury to care can optimize trauma patient outcomes. A previous study of prehospital transport of US military casualties during the Afghanistan conflict demonstrated the importance of time and treatment capability for combat casualty survival.
METHODS
A retrospective descriptive analysis was conducted to analyze battlefield data collected on US military combat casualties during the Iraq conflict from March 19, 2003, to August 31, 2010. All casualties were analyzed by mortality outcome (killed in action, died of wounds, case fatality rate) and compared with Afghanistan conflict. Detailed data for those who underwent prehospital transport were analyzed for effects of transport time, injury severity, and blood transfusion on survival.
RESULTS
For the total population, percent killed in action (16.6% vs. 11.1%), percent died of wounds (5.9% vs. 4.3%), and case fatality rate (10.0 vs. 8.6) were higher for Iraq versus Afghanistan (p < 0.001). Among 1,692 casualties (mean New Injury Severity Score, 22.5; mortality, 17.6%) with detailed data, the injury mechanism included 77.7% from explosions and 22.1% from gunshot wounds. For prehospital transport, 67.6% of casualties were transported within 60 minutes, and 32.4% of casualties were transported in greater than 60 minutes. Although 97.0% of deaths occurred in critical casualties (New Injury Severity Score, 25-75), 52.7% of critical casualties survived. Critical casualties were transported more rapidly (p < 0.01) and more frequently within 60 minutes (p < 0.01) than other casualties. Critical casualties had lower mortality when blood was received (p < 0.01). Among critical casualties, blood transfusion was associated with survival irrespective of transport time within or greater than 60 minutes (p < 0.01).
CONCLUSION
Although data were limited, early blood transfusion was associated with battlefield survival in Iraq as it was in Afghanistan.
LEVEL OF EVIDENCE
Performance improvement and epidemiological, level IV.
背景
减少从受伤到救治的时间可以优化创伤患者的预后。此前一项关于阿富汗冲突期间美国军事伤员前送的研究表明，时间和治疗能力对战斗伤员的生存至关重要。
方法
对 2003 年 3 月 19 日至 2010 年 8 月 31 日期间伊拉克冲突中美国军事战斗伤员的战场数据进行回顾性描述性分析。根据死亡结局（阵亡、因伤死亡、病死率）对所有伤员进行分析，并与阿富汗冲突进行比较。对接受前送治疗的伤员进行详细数据分析，评估前送时间、损伤严重程度和输血对生存的影响。
结果
对于总人群，伊拉克的阵亡率（16.6%比 11.1%）、因伤死亡（5.9%比 4.3%）和病死率（10.0%比 8.6%）均高于阿富汗（p<0.001）。在有详细数据的 1692 名伤员中（平均新损伤严重度评分 22.5，死亡率 17.6%），损伤机制包括 77.7%的爆炸伤和 22.1%的枪伤。在院前转运中，67.6%的伤员在 60 分钟内转运，32.4%的伤员在 60 分钟以上转运。虽然 97.0%的死亡发生在危重伤员（新损伤严重度评分 25-75）中，但仍有 52.7%的危重伤员存活。危重伤员转运更快（p<0.01），60 分钟内转运更频繁（p<0.01）。危重伤员接受输血时死亡率较低（p<0.01）。在危重伤员中，无论 60 分钟内或 60 分钟以上转运，输血均与生存相关（p<0.01）。
结论
尽管数据有限，但在伊拉克，早期输血与阿富汗一样与战场生存相关。
证据等级
改进和流行病学，四级。
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