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En-Route Care Capability From Point of Injury Impacts Mortality After Severe Wartime Injury.
MedLine Citation:
PMID:  23291661     Owner:  NLM     Status:  Publisher    
OBJECTIVE:: The objective of this study is to characterize modern point-of-injury (POI) en-route care platforms and to compare mortality among casualties evacuated with conventional military retrieval (CMR) methods to those evacuated with an advanced medical retrieval (AMR) capability. BACKGROUND:: Following a decade of war in Afghanistan, the impact of en-route care capabilities from the POI on mortality is unknown. METHODS:: Casualties evacuated from POI to one level III facility in Afghanistan (July 2008-March 2012) were identified from UK and US trauma registries. Groups comprised those evacuated by a medically qualified provider-led, AMR and those by a medic-led CMR capability. Outcomes were compared per incremental Injury Severity Score (ISS) bins. RESULTS:: Most casualties (n = 1054; 61.2%) were in the low-ISS (1-15) bracket in which there was no difference in en-route care time or mortality between AMR and CMR. Casualties in the mid-ISS bracket (16-50) (n = 583; 33.4%) experienced the same median en-route care time (minutes) on AMR and CMR platforms [78 (58) vs 75 (93); P = 0.542] although those on AMR had shorter time to operation [110 (95) vs 117 (126); P < 0.001]. In this mid-ISS bracket, mortality was lower in the AMR than in the CMR group (12.2% vs 18.2%; P = 0.035). In the high-ISS category (51-75) (n = 75; 4.6%), time to operation was lower in the AMR than the CMR group (66 ± 77 vs 113 ± 122; P = 0.013) but there was no difference in mortality. CONCLUSIONS:: This study characterizes en-route care capabilities from POI in modern combat. Conventional platforms are effective in most casualties with low injury severity. However, a definable injury severity exists for which evacuation with an AMR capability is associated with improved survival.
Jonathan J Morrison; John Oh; Joseph J Dubose; David J Oʼreilly; Robert J Russell; Lorne H Blackbourne; Mark J Midwinter; Todd E Rasmussen
Publication Detail:
Journal Detail:
Title:  Annals of surgery     Volume:  257     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-1-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  330-334     Citation Subset:  -    
*United States Army Institute of Surgical Research, Fort Sam Houston, TX †The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK ‡Landstuhl Regional Medical Centre, Landstuhl, Germany §C-STARS Baltimore, R Adams Cowley Shock Trauma Center, Baltimore, MD ¶The Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK ‖59th Medical Deployment Wing, Science and Technology Section, Lackland Air Force Base, TX **The Norman M. Rich Department of Surgery, the Uniformed Services University of the Health Sciences, Bethesda, MD.
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