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Reexamination of a Battlefield Trauma Golden Hour Policy.

Abstract Most combat casualties who die, do so in the prehospital setting. Efforts directed toward alleviating prehospital combat trauma death, known as killed in action (KIA) mortality, have the greatest opportunity for eliminating preventable death.
PMID
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Re-examination of a Battlefield Trauma Golden Hour Policy.

Authors

Mayor MeshTerms

Afghan Campaign 2001-

Emergency Medical Services

Military Medicine

Policy

Keywords
Journal Title the journal of trauma and acute care surgery
Publication Year Start




PMID- 29266051
OWN - NLM
STAT- MEDLINE
DCOM- 20180102
LR  - 20180102
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Linking)
VI  - 84
IP  - 1
DP  - 2018 Jan
TI  - Reexamination of a Battlefield Trauma Golden Hour Policy.
PG  - 11-18
LID - 10.1097/TA.0000000000001727 [doi]
AB  - BACKGROUND: Most combat casualties who die, do so in the prehospital setting.
      Efforts directed toward alleviating prehospital combat trauma death, known as
      killed in action (KIA) mortality, have the greatest opportunity for eliminating
      preventable death. METHODS: Four thousand five hundred forty-two military
      casualties injured in Afghanistan from September 11, 2001, to March 31, 2014,
      were included in this retrospective analysis to evaluate proposed explanations
      for observed KIA reduction after a mandate by Secretary of Defense Robert M.
      Gates that transport of injured service members occur within 60 minutes. Using
      inverse probability weighting to account for selection bias, data were analyzed
      using multivariable logistic regression and simulation analysis to estimate the
      effects of (1) gradual improvement, (2) damage control resuscitation, (3) harm
      from inadequate resources, (4) change in wound pattern, and (5) transport time on
      KIA mortality. RESULTS: The effect of gradual improvement measured as a time
      trend was not significant (adjusted odds ratio [AOR], 0.99; 95% confidence
      interval [CI], 0.94-1.03; p = 0.58). For casualties with military Injury Severity
      Score of 25 or higher, the odds of KIA mortality were 83% lower for casualties
      who needed and received prehospital blood transfusion (AOR, 0.17; 95% CI,
      0.06-0.51; p = 0.002); 33% lower for casualties receiving initial treatment by
      forward surgical teams (AOR, 0.67; 95% CI, 0.58-0.78; p < 0.001); 70%, 74%, and
      87% lower for casualties with dominant injuries to head (AOR, 0.30; 95% CI,
      0.23-0.38; p < 0.001), abdomen (AOR, 0.26, 95% CI, 0.19-0.36; p < 0.001) and
      extremities (AOR, 0.13; 95% CI, 0.09-0.17; p < 0.001); 35% lower for casualties
      categorized with blunt injuries (AOR, 0.65; 95% CI, 0.46-0.92; p = 0.01); and 39%
      lower for casualties transported within one hour (AOR, 0.61; 95% CI, 0.51-0.74; p
      < 0.001). Results of simulations in which transport times had not changed after
      the mandate indicate that KIA mortality would have been 1.4% higher than
      observed, equating to 135 more KIA deaths (95% CI, 105-164). CONCLUSION:
      Reduction in KIA mortality is associated with early treatment capabilities, blunt
      mechanism, select body locations of injury, and rapid transport. LEVEL OF
      EVIDENCE: Therapy, level III.
FAU - Howard, Jeffrey T
AU  - Howard JT
AD  - From the US Army Institute of Surgical Research (J.T.H.), Department of Defense
      Joint Trauma System (R.S.K., Z.T.S.), Joint Base San Antonio-Fort Sam Houston,
      Texas; Uniformed Services University of the Health Sciences (R.S.K., M.J.M.),
      Bethesda, Maryland; Texas A&M Health Science Center, College of Medicine (R.S.K.,
      M.J.M.), Texas A&M University, College Station, Texas; The Pennsylvania State
      University (A.R.S.), University Park, PA; Department of Surgery (M.J.M.), US
      Army, Madigan Army Medical Center, Tacoma, Washington; and Bureau of Medicine and
      Surgery (Z.T.S.), US Navy, Falls Church, Virginia.
FAU - Kotwal, Russ S
AU  - Kotwal RS
FAU - Santos-Lazada, Alexis R
AU  - Santos-Lazada AR
FAU - Martin, Matthew J
AU  - Martin MJ
FAU - Stockinger, Zsolt T
AU  - Stockinger ZT
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
SB  - AIM
SB  - IM
MH  - Adult
MH  - *Afghan Campaign 2001-
MH  - Blood Transfusion
MH  - *Emergency Medical Services
MH  - Female
MH  - Humans
MH  - Injury Severity Score
MH  - Male
MH  - *Military Medicine
MH  - *Policy
MH  - Retrospective Studies
MH  - Wounds and Injuries/*mortality
MH  - Young Adult
EDAT- 2017/12/22 06:00
MHDA- 2018/01/03 06:00
CRDT- 2017/12/22 06:00
PHST- 2017/12/22 06:00 [entrez]
PHST- 2017/12/22 06:00 [pubmed]
PHST- 2018/01/03 06:00 [medline]
AID - 10.1097/TA.0000000000001727 [doi]
AID - 01586154-201801000-00002 [pii]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2018 Jan;84(1):11-18. doi: 10.1097/TA.0000000000001727.