59th Medical Wing, JBSA Lackland, TX.
40th Forward Resuscitation and Surgical Detachment, 627 Hospital Center, 1st Medical Brigade, Fort Carson, CO; and Uniformed Services University of the Health Sciences, Bethesda, MD.
Med J (Ft Sam Houst Tex). 2022 Apr-Jun(Per 22-04/05/06):32-39.
Uncontested air movement and advances for medical care of combat casualties have resulted in a decreased case fatality rate. However, in future large-scale combat operations, the military has established a plan for multidomain operations to defeat near-peer adversaries. Prolonged casualty care and mass casualty scenarios will become more prevalent. Prehospital friendly scoring systems such as the shock index (SI) and revised trauma score (RTS) may provide useful triage data. Development of accurate, data-driven, triage systems will be key to optimize management of resources, care, and transport of combat casualties.
We included data from the Department of Defense Trauma Registry between 01 January 2007 to 17 March 2020. Data comprised of adult US military or coalition service members for analysis as the baseline cohort, and those who died within 24 hours were included in the early death cohort. We performed statistical analysis on demographics and injury data, SI and RTS to measure the receiver operating characteristics (ROC) of each value to predict early death.
The early death cohort had a significantly higher injury severity score (25 vs. 5) and a higher percentage of serious injuries in every body region than the baseline cohort. The early death cohort sustained serious injuries to the head and neck at a rate five times that of the baseline cohort (43.4% vs 8.1%) with odds ratio (OR) of death 8.0 (95% confidence interval 5.7-11.1) followed by skin (13.6% versus 1.9%) with an OR of 6.3 (95% CI 3.8-10.3). The mean SI was 1.21 versus 0.80. The revised trauma score (RTS) was 4.18 versus 7.34. The RTS had a higher area under the receiver operating characteristic (0.896 versus 0.716 for SI).
Serious injuries to the head and skin were most strongly associated with death within the first 24 hours. The RTS appears to be a more accurate tool than SI alone for assessing injury mortality. Military medical personnel should consider these factors when triaging casualties during future conflicts in resource limited settings with delayed evacuation.
无障碍的空中行动和医疗保健的进步，使战斗伤亡的病死率降低。 然而，在未来的大规模作战行动中，军方已经制定了多领域作战计划，以击败近敌对手。 延长的伤员救治和大规模伤员场景将变得更加普遍。 院前友好的评分系统，如休克指数（SI）和修订创伤评分（RTS），可能提供有用的分诊数据。 开发准确、数据驱动的分诊系统将是优化资源管理、伤员救治和战斗伤员后送的关键。
我们纳入了 2007 年 1 月 1 日至 2020 年 3 月 17 日期间国防部创伤登记处的数据。数据包括作为基线队列的成年美国军事人员或联军服务人员，以及在 24 小时内死亡的人员纳入早期死亡队列。我们对人口统计学和损伤数据、SI 和 RTS 进行了统计分析，以衡量每个值预测早期死亡的受试者工作特征（ROC）。
早期死亡队列的损伤严重程度评分（25 分 vs. 5 分）显著高于基线队列，每个身体区域严重损伤的比例也高于基线队列。早期死亡队列头部和颈部严重损伤的发生率是基线队列的五倍（43.4% vs. 8.1%），死亡的优势比（OR）为 8.0（95%置信区间 5.7-11.1），其次是皮肤（13.6% vs. 1.9%），OR 为 6.3（95%置信区间 3.8-10.3）。平均 SI 为 1.21 比 0.80。修订创伤评分（RTS）为 4.18 比 7.34。RTS 的受试者工作特征曲线下面积（AUC）高于 SI（0.896 比 0.716）。
头部和皮肤的严重损伤与 24 小时内死亡的关系最密切。RTS 似乎比 SI 更能准确评估损伤死亡率。在资源有限、后送延迟的未来冲突中，军事医务人员在分诊伤员时应考虑这些因素。
