创伤专家共识：早期即需要具备相应能力以提高创伤伤者的生存几率。
A trauma expert consensus: Capabilities are required early to improve survivability from traumatic injury.
作者信息
Gurney Jennifer M, Kotwal Russ S, Holcomb John B, Staudt Amanda M, Eastridge Brian, Sirkin Max, Jensen Shane, Shackelford Stacy, Sonka Brian J, Wilson Justin, Montgomery Harold, Gross Kirby, Warren Wendy, Mazuchowski Edward, Rohrer Andrew J
机构信息
From the Joint Trauma System (J.M.G., R.S.K., S.J., B.J.S., J.W., H.M., A.J.R.), Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, Texas; Department of Surgery (J.M.G., S.S., S.J., E.M.), Department of Military and Emergency Medicine (R.S.K., E.M.), and Department of Pathology (A.J.R., E.M.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Trauma and Acute Care Surgery (J.B.H.), University of Alabama at Birmingham, Birmingham, Alabama; The Geneva Foundation (A.M.S.), US Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston; Department of Surgery, Trauma and Acute Care Surgery (B.E.), University of Texas Health San Antonio, San Antonio, Texas; Joint Medical Unit (M.S.), Joint Special Operations Command, United States Special Operations Command, Fort Liberty, North Carolina; San Antonio Uniformed Services Health Education Consortium (M.S.), Joint Base San Antonio-Fort Sam Houston, Texas; Defense Health Agency (S.J., S.S.), Colorado Trauma Medical Director, Colorado Springs, Colorado; Department of Trauma and Acute Care Surgery (K.G.), Cooper University Medical Center, Camden, New Jersey; HNL Lab Medicine (E.M.), Allentown, Pennsylvania; and Armed Forces Medical Examiner System (W.W., A.J.R.), Defense Health Agency, Dover Air Force Base, Delaware.
出版信息
J Trauma Acute Care Surg. 2024 Aug 1;97(2S Suppl 1):S82-S90. doi: 10.1097/TA.0000000000004414. Epub 2024 Jul 12.
BACKGROUND
Mortality reviews examine US military fatalities resulting from traumatic injuries during combat operations. These reviews are essential to the evolution of the military trauma system to improve individual, unit, and system-level trauma care delivery and inform trauma system protocols and guidelines. This study identifies specific prehospital and hospital interventions with the potential to provide survival benefits.
METHODS
US Special Operations Command fatalities with battle injuries deemed potentially survivable (2001-2021) were extracted from previous mortality reviews. A military trauma review panel consisting of trauma surgeons, forensic pathologists, and prehospital and emergency medicine specialists conducted a methodical review to identify prehospital, hospital, and resuscitation interventions (e.g., laparotomy, blood transfusion) with the potential to have provided a survival benefit.
RESULTS
Of 388 US Special Operations Command battle-injured fatalities, 100 were deemed potentially survivable. Of these (median age, 29 years; all male), 76.0% were injured in Afghanistan, and 75% died prehospital. Gunshot wounds were in 62.0%, followed by blast injury (37%), and blunt force injury (1.0%). Most had a Maximum Abbreviated Injury Scale severity classified as 4 (severe) (55.0%) and 5 (critical) (41.0%). The panel recommended 433 interventions (prehospital, 188; hospital, 315). The most recommended prehospital intervention was blood transfusion (95%), followed by finger/tube thoracostomy (47%). The most common hospital recommendations were thoracotomy and definitive vascular repair. Whole blood transfusion was assessed for each fatality: 74% would have required ≥10 U of blood, 20% would have required 5 to 10 U, 1% would have required 1 to 4 U, and 5% would not have required blood products to impact survival. Five may have benefited from a prehospital laparotomy.
CONCLUSION
This study systematically identified capabilities needed to provide a survival benefit and examined interventions needed to inform trauma system efforts along the continuum of care. The determination was that blood transfusion and massive transfusion shortly after traumatic injury would impact survival the most.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level V.
背景
死亡率审查旨在研究美国军事人员在战斗行动中因创伤性损伤导致的死亡情况。这些审查对于军事创伤系统的发展至关重要，有助于改善个人、部队和系统层面的创伤护理服务，并为创伤系统的协议和指南提供参考。本研究确定了具有潜在生存益处的特定院前和院内干预措施。
方法
从先前的死亡率审查中提取美国特种作战司令部被认为有潜在存活可能的战斗受伤死亡人员（2001 - 2021年）。一个由创伤外科医生、法医病理学家以及院前和急诊医学专家组成的军事创伤审查小组进行了系统审查，以确定有可能提供生存益处的院前、院内和复苏干预措施（例如剖腹手术、输血）。
结果
在美国特种作战司令部388例战斗受伤死亡人员中，100例被认为有潜在存活可能。其中（中位年龄29岁；均为男性），76.0%在阿富汗受伤，75%在院前死亡。枪伤占62.0%，其次是爆炸伤（37%）和钝器伤（1.0%）。大多数人的简明损伤定级标准（AIS）严重程度被分类为4级（重度）（55.0%）和5级（极重度）（41.0%）。审查小组推荐了433项干预措施（院前188项；院内315项）。最常被推荐的院前干预措施是输血（95%），其次是手指/胸管胸廓造口术（47%）。最常见的院内建议是开胸手术和确定性血管修复。对每例死亡人员评估了全血输注情况：74%的人需要≥10单位血液，20%的人需要5至10单位，1%的人需要1至4单位，5%的人不需要血液制品即可影响生存。5人可能从院前剖腹手术中获益。
结论
本研究系统地确定了提供生存益处所需的能力，并审查了在连续护理过程中为创伤系统工作提供信息所需的干预措施。确定创伤后不久进行输血和大量输血对生存影响最大。
证据级别
预后和流行病学；V级。
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