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Impact of prehospital medical evacuation (MEDEVAc) transport time on combat mortality in patients with noncompressible torso injury and traumatic amputations: a retrospective study

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Military Medical Research 2019年第1期6卷 23-30页

作者： Joseph K.Maddry crystal A.Perez Alejandra G.Mora Jill D.Lear shelia c.savell Vikhyat S.Bebarta US Air Force En route care Research center 59th MDW/ST Chief Scientist's Office –US Army Institute of Surgical research JBSA Ft.Sam Houston Department of Emergency Medicine San Antonio Military Medical CenterJBSA Ft. Sam Houston US Air Force En route care Research center 59th MDW/ST Chief Scientist's Office –US Army Institute of Surgical researchJBSA Ft.Sam Houston Department of Emergency Medicine University of Colorado School of Medicine

Background: In combat operations, patients with traumatic injuries require expeditious evacuation to improve survival. Studies have shown that long transport times are associated with increased morbidity and mortality. Limited data exist on the influence of transport time on patient outcomes with specific injury types. The objective of this study was to determine the impact of the duration of time from the initial request for medical evacuation to arrival at a medical treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and noncompressible torso injury(NcTI).Methods: We completed a retrospective review of MEDEVAc patient care records for United States military personnel who sustained traumatic amputations and NcTI during Operation Enduring Freedom between January 2011 and March 2014. We grouped patients as traumatic amputation and NcTI(AMP+NcTI), traumatic amputation only(AMP),and neither AMP nor NcTI(Non-AMP/NcTI). Analysis was performed using chi-squared tests, Fisher's exact tests,cochran-Armitage Trend tests, Shapiro-Wilks tests, Wilcoxon and Kruskal-Wallis techniques and cox proportional hazards regression ***: We reviewed 1267 records, of which 669 had an injury severity score(ISS) of 10 or greater and were included in the analysis. In the study population, 15.5% sustained only amputation injuries(n=104, AMP only), 10.8% sustained amputation and NcTI(n=72, AMP+NcTI), and 73.7% did not sustain either an amputation or an NcTI(n=493,Non-AMP/NcTI). AMP+NcTI had the highest mortality(16.7%) with transport time greater than 60 min. While the AMP+NcTI group had decreasing survival with longer transport times, AMP and Non-AMP/NcTI did not exhibit the same ***: A decreased transport time from the point of injury to a medical treatment facility was associated with decreased mortality in patients who suffered a combination of amputation injury and NcTI. No significant association between transport time

关键词： Transport time Non-compressible torso injury Traumatic amputation combat

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