Adjutant General Captains Career Course, Fort Jackson, SC 29207, USA.
14th Field Hospital, Fort Stewart, GA, USA.
Mil Med. 2024 Feb 27;189(3-4):e606-e611. doi: 10.1093/milmed/usad323.
Current Tactical Combat Casualty Care (TCCC) guidelines recommend antibiotic administration for all open wounds to prevent infection. We identified associations between demographics, procedures, and medicines with the receipt of prehospital antibiotics among combat casualties.
We used a series of emergency department procedure codes to identify adult subjects within the Department of Defense Trauma Registry from January 2007 to August 2016 who sustained open wounds. We compared demographics, procedures, and medicines administered among casualties receiving prehospital wound prophylaxis versus casualties not receiving antibiotic prophylaxis. We controlled for confounders with multivariable logistical regression.
We identified 18,366 encounters meeting inclusion criteria. Antibiotic recipients (n = 2384) were comparable to nonrecipients (n = 15,982) with regard to age and sex. Antibiotic recipients were more likely to sustain injuries from firearms and undergo all procedures examined related to hemorrhage control, airway management, pneumothorax treatment, and volume replacement except for intraosseous access. Antibiotic recipients were less likely to sustain injuries from explosives. Antibiotic recipients had a modestly higher survival than nonrecipients (97.4% versus 96.0%). Associations with prehospital antibiotic receipt in multivariable logistic regression included non-North Atlantic Treaty Organization military force affiliation (odds ratio (OR) 4.65, 95% CI, 1.0-20.8), tachycardia (OR 3.4, 95% CI, 1.1-10.5), intubation (OR 2.0, 95% CI, 1.1-3.8), and administration of tranexamic acid (OR 5.6, 95% CI, 1.2-26.5).
The proportion of combat casualties with open wounds receiving prehospital antibiotics was low despite published recommendations for early antibiotics in patients with open wounds. These findings highlight the ongoing need for additional educational and quality assurance initiatives to continue improving adherence to TCCC guidelines with regard to prehospital antibiotic administration. Future studies are necessary to determine reasons for suboptimal TCCC guideline compliance.
目前的战术战伤救治（TCCC）指南建议对所有开放性伤口使用抗生素以预防感染。我们确定了在战斗伤员中，与接受院前抗生素治疗相关的人口统计学、程序和药物之间的关联。
我们使用一系列急诊程序代码，在 2007 年 1 月至 2016 年 8 月期间从国防部创伤登记处中确定了患有开放性伤口的成年患者。我们比较了接受院前伤口预防用药和未接受抗生素预防用药的伤员的人口统计学、程序和用药情况。我们通过多变量逻辑回归控制混杂因素。
我们确定了符合纳入标准的 18366 例就诊。抗生素使用者（n=2384）与非使用者（n=15982）在年龄和性别方面相似。与其他接受检查的程序相比，抗生素使用者更有可能因枪支受伤并接受所有与控制出血、气道管理、气胸治疗和容量替代相关的程序，除了骨髓腔穿刺术。抗生素使用者因爆炸物受伤的可能性较低。抗生素使用者的存活率略高于非使用者（97.4%比 96.0%）。多变量逻辑回归中与院前使用抗生素相关的因素包括不属于北大西洋公约组织军事力量（比值比（OR）4.65，95%置信区间，1.0-20.8）、心动过速（OR 3.4，95%置信区间，1.1-10.5）、插管（OR 2.0，95%置信区间，1.1-3.8）和氨甲环酸的使用（OR 5.6，95%置信区间，1.2-26.5）。
尽管发表的开放性伤口患者早期使用抗生素的建议，但接受院前抗生素治疗的开放性伤口战斗伤员比例较低。这些发现突出表明，需要进一步开展教育和质量保证活动，以继续提高对 TCCC 指南中院前抗生素使用的遵守情况。需要进一步的研究来确定 TCCC 指南遵守情况不佳的原因。
