US Air Force En route Care Research Center 59th MDW/ST, Chief Scientist's Office -US Army Institute of Surgical research, JBSA Ft. Sam Houston, San Antonio, TX, USA.
Department of Emergency Medicine, San Antonio Military Medical Center, JBSA Ft. Sam Houston, San Antonio, TX, USA.
Mil Med Res. 2018 Jun 30;5(1):22. doi: 10.1186/s40779-018-0169-2.
In combat operations, patients with traumatic injuries require expeditious evacuation to improve survival. Studies have shown that long transport times are associated with increased morbidity and mortality. Limited data exist on the influence of transport time on patient outcomes with specific injury types. The objective of this study was to determine the impact of the duration of time from the initial request for medical evacuation to arrival at a medical treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and non-compressible torso injury (NCTI).
We completed a retrospective review of MEDEVAC patient care records for United States military personnel who sustained traumatic amputations and NCTI during Operation Enduring Freedom between January 2011 and March 2014. We grouped patients as traumatic amputation and NCTI (AMP+NCTI), traumatic amputation only (AMP), and neither AMP nor NCTI (Non-AMP/NCTI). Analysis was performed using chi-squared tests, Fisher's exact tests, Cochran-Armitage Trend tests, Shapiro-Wilks tests, Wilcoxon and Kruskal-Wallis techniques and Cox proportional hazards regression modeling.
We reviewed 1267 records, of which 669 had an injury severity score (ISS) of 10 or greater and were included in the analysis. In the study population, 15.5% sustained only amputation injuries (n=104, AMP only), 10.8% sustained amputation and NCTI (n=72, AMP+NCTI), and 73.7% did not sustain either an amputation or an NCTI (n=493, Non-AMP/NCTI). AMP+NCTI had the highest mortality (16.7%) with transport time greater than 60 min. While the AMP+NCTI group had decreasing survival with longer transport times, AMP and Non-AMP/NCTI did not exhibit the same trend.
A decreased transport time from the point of injury to a medical treatment facility was associated with decreased mortality in patients who suffered a combination of amputation injury and NCTI. No significant association between transport time and outcomes was found in patients who did not sustain NCTI. Priority for rapid evacuation of combat casualties should be given to those with NCTI.
在作战行动中，创伤患者需要迅速撤离以提高生存率。研究表明，运输时间长与发病率和死亡率增加有关。关于特定损伤类型的患者结局与运输时间的影响，现有数据有限。本研究的目的是确定从最初请求医疗后送至到达医疗救治设施的时间长短对创伤性肢体截肢和非压缩性躯干损伤（NCTI）伤员发病率和死亡率的影响。
我们对 2011 年 1 月至 2014 年 3 月期间在持久自由行动中遭受创伤性截肢和 NCTI 的美国军事人员的 MEDEVAC 患者护理记录进行了回顾性审查。我们将患者分为创伤性截肢和 NCTI（AMP+NCTI）、单纯创伤性截肢（AMP）和既无 AMP 也无 NCTI（非 AMP/NCTI）。采用卡方检验、Fisher 确切检验、Cochran-Armitage 趋势检验、Shapiro-Wilks 检验、Wilcoxon 和 Kruskal-Wallis 检验以及 Cox 比例风险回归模型进行分析。
我们回顾了 1267 份记录，其中 669 份损伤严重程度评分（ISS）为 10 或更高，纳入了分析。在研究人群中，15.5%（n=104）仅发生截肢损伤，10.8%（n=72）发生截肢和 NCTI，73.7%（n=493）既未发生截肢也未发生 NCTI。AMP+NCTI 组的死亡率最高（16.7%），转运时间大于 60 分钟。虽然 AMP+NCTI 组随着转运时间的延长存活率下降，但 AMP 和非 AMP/NCTI 组没有表现出相同的趋势。
从受伤点到医疗救治设施的转运时间缩短与遭受截肢损伤和 NCTI 组合的患者死亡率降低有关。未发生 NCTI 的患者，转运时间与结局之间无显著关联。应优先快速撤离有 NCTI 的战场伤员。
