Arnold Jacob L, MacDonald Austin G, Baker Jay B, Rizzo Julie A, April Michael D, Schauer Steven G
Uniformed Services University of the Health Sciences, Bethesda, MD; and Brooke Army Medical Center, JBSA Fort Sam Houston, TX.
Brooke Army Medical Center, JBSA Fort Sam Houston, TX.
Med J (Ft Sam Houst Tex). 2023 Jan-Mar(Per 23-1/2/3):28-33.
The US military is transitioning into a posture preparing for large-scale combat operations in which delays in evacuation may become common. It remains unclear which casualty population can have their initial surgical interventions delayed, thus reducing the evacuation demands.
We performed a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry (DODTR) focused on casualties who received prehospital care. In this, we sought to determine (1) of those who underwent operative intervention, the proportion of surgeries occurring ≥3 days post-injury, and (2) of those who underwent early versus delayed surgery, the proportions who required blood products.
There were 6,558 US military casualties who underwent surgical intervention-6,224 early (less than 3 days from injury) and 333 delayed (≥ 3 days from injury). The median Injury Severity Score (ISS) was higher in the early cohort (10 versus 6, p is less than 0.001). Serious injuries to the head were more common in the early cohort (12% versus 5%, p is less than 0.001), as were the thorax (13% versus 9%, p=0.041), abdomen (10% versus 5%, p=0.001), extremities (37% versus 14%, p is less than 0.001), and skin (4% versus less than 1%, p=0.001). Survival to discharge was lower in the early cohort (97% versus 100%, p is less than 0.001). Mean whole blood consumption was higher in the early cohort (0.5 versus 0 units, p is less than 0.001), as was packed red blood cells (6.3 versus 0.5, p is less than 0.001), platelets (0.9 versus 0, p is less than 0.001), and fresh frozen plasma (4.5 versus 0.2, p is less than 0.001). The administration of any units of packed red blood cells and whole blood was higher for the early cohort (37% versus 7%, p is less than 0.001), as was a ≥3 units threshold (30% versus 3%, p is less than 0.001), and ≥10 units threshold (18% versus 1%, p is less than 0.001).
Few combat casualties underwent delayed surgical interventions defined as ≥3 days post injury, and only a small number of casualties with delayed surgical intervention received blood products. Casualties who received early surgical intervention were more likely to have higher injury severity scores, and more likely to receive blood.
美国军队正在转型为一种为大规模作战行动做准备的态势，在这种情况下，后送延迟可能会变得很常见。目前尚不清楚哪些伤员群体可以延迟其初始手术干预，从而减少后送需求。
我们对先前描述的来自国防部创伤登记处（DODTR）的数据集进行了二次分析，该数据集侧重于接受院前治疗的伤员。在此分析中，我们试图确定：（1）在接受手术干预的伤员中，受伤后≥3天进行手术的比例；（2）在接受早期手术与延迟手术的伤员中，需要血液制品的比例。
共有6558名美国军队伤员接受了手术干预，其中6224例为早期手术（受伤后不到3天），333例为延迟手术（受伤后≥3天）。早期队列的损伤严重程度评分中位数较高（分别为10分和6分，p<0.001）。早期队列中头部重伤更为常见（分别为12%和5%，p<0.001），胸部重伤也较为常见（分别为13%和9%，p=0.041），腹部重伤（分别为10%和5%，p=0.001）、四肢重伤（分别为37%和14%，p<0.001）以及皮肤重伤（分别为4%和不到1%，p=0.001）。早期队列的出院生存率较低（分别为97%和100%，p<0.001）。早期队列的平均全血消耗量较高（分别为0.5单位和0单位，p<0.001），浓缩红细胞（分别为6.3单位和0.5单位，p<0.001）、血小板（分别为0.9单位和0单位，p<0.001）以及新鲜冰冻血浆（分别为4.5单位和0.2单位，p<0.001）的消耗量也较高。早期队列中接受任何单位浓缩红细胞和全血输注的比例更高（分别为37%和7%，p<0.001），输注≥3单位的阈值比例更高（分别为30%和3%，p<0.001），输注≥10单位的阈值比例更高（分别为18%和1%，p<0.001）。
很少有战斗伤员接受定义为受伤后≥3天的延迟手术干预，并且只有少数接受延迟手术干预的伤员接受了血液制品。接受早期手术干预的伤员更有可能具有较高的损伤严重程度评分，并且更有可能接受输血。
