Keneally Ryan J, Meyers Brittney A, Shields Cynthia H, Ricca Robert, Creamer Kevin M
Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC 20052, USA.
Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2022 Mar 28;187(3-4):e338-e342. doi: 10.1093/milmed/usab020.
The authors compared pediatric thoracic patients in the Joint Theatre Trauma Registry (JTTR) to those in the National Trauma Data Bank (NTDB) to assess differences in patient mortality rates and mortality risk accounting for age, injury patterns, and injury severity.
Patients less than 19 years of age with thoracic trauma were identified in both the JTTR and NTDB. Multiple logistic regression, χ2, Student's t-test, or Mann-Whitney U test were used as indicated to compare the two groups.
Pediatric thoracic trauma patients seen in Iraq and Afghanistan (n = 955) had a significantly higher mortality rate (15.1 vs. 6.0%, P <.01) than those in the NTDB (n = 9085). After controlling for covariates between the JTTR and the NTDB, there was no difference in mortality (odds ratio for mortality for U.S. patients was 0.74, 95% CI 0.52-1.06, P = .10). The patients seen in Iraq or Afghanistan were significantly younger (8 years old, interquartile ratio (IQR) 2-13 vs. 15, IQR 10-17, P <.01) had greater severity of injuries (injury severity score 17, IQR 12-26 vs. 12, IQR 8-22, P <.01), had significantly more head injuries (29 vs. 14%, P <.01), and over half were exposed to a blast.
Pediatric patients with thoracic trauma in Iraq and Afghanistan in the JTTR had similar mortality rates compared to the civilian population in the NTDB after accounting for confounding covariates. These findings indicate that deployed military medical professionals are providing comparable quality of care in extremely challenging circumstances. This information has important implications for military preparedness, medical training, and casualty care.
作者将联合战区创伤登记处（JTTR）中的儿科胸部创伤患者与国家创伤数据库（NTDB）中的患者进行比较，以评估患者死亡率及考虑年龄、损伤模式和损伤严重程度后的死亡风险差异。
在JTTR和NTDB中识别出年龄小于19岁的胸部创伤患者。根据需要使用多元逻辑回归、χ²检验、学生t检验或曼-惠特尼U检验来比较两组。
在伊拉克和阿富汗就诊的儿科胸部创伤患者（n = 955）的死亡率（15.1%对6.0%，P <.01）显著高于NTDB中的患者（n = 9085）。在控制JTTR和NTDB之间的协变量后，死亡率没有差异（美国患者的死亡比值比为0.74，95%置信区间为0.52 - 1.06，P = 0.10）。在伊拉克或阿富汗就诊的患者明显更年轻（8岁，四分位间距（IQR）为2 - 13岁对15岁，IQR为10 - 17岁，P <.01），损伤更严重（损伤严重程度评分17，IQR为12 - 26对12，IQR为8 - 22，P <.01），头部损伤显著更多（29%对14%，P <.01），并且超过一半的患者暴露于爆炸。
在考虑混杂协变量后，JTTR中伊拉克和阿富汗的儿科胸部创伤患者与NTDB中的平民人口死亡率相似。这些发现表明，部署的军事医疗专业人员在极具挑战性的情况下提供了可比的医疗质量。这一信息对军事准备、医学培训和伤员护理具有重要意义。
