Committee on Surgical Combat Casualty Care position statement: Neurosurgical capability for the optimal management of traumatic brain injury during deployed operations.

Autor:	Gurney JM; From the Joint Trauma System (J.M.G., R.S.K., J.C.G., B.J.S., S.D.J.), DoD Center of Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston, Texas; Department of Surgery (M.D.T.), Navy Medical Center San Diego, San Diego, California; Department of Neurosurgery (B.A.D.), Walter Reed National Military Medical Center, Bethesda, Maryland; US+UAE Trauma (B.J.G.), Burn, and Rehabilitative Medicine Mission; Department of Surgery (M.S.D.) and Department of Neurosurgery (M.S.D.), Womack Army Medical Center, Fort Bragg, North Carolina; Uniformed Service University of Health Sciences (J.B.H., R.S.K., J.W.C., M.J.E., M.A.S., M.J.M.), Bethesda, Maryland; Division of Trauma and Acute Care Surgery, Department of Surgery (J.B.H.), University of Alabama at Birmingham, Birmingham, Alabama; Department of Surgery (L.C.B.), Madigan Army Medical Center, Joint Base Lewis-McChord, Washington; Department of Trauma, Surgical Critical Care and Emergency Surgery (J.W.C.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; 1st Medical Battalion (T.E.), 1st Marine Logistics Group, Oceanside, California; Division of Trauma (J.C.G., B.J.S.), Brooke Army Medical Center, Joint Base San Antonio, San Antonio, Texas; Traumatic Brain Injury Center of Excellence (TBICoE) (D.W.M.), Silver Spring, MD; General Dynamics Information Technology (D.W.M.), Falls Church, VA; Division of Acute Care Surgery Joint Medical Unit (M.J.E.), University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; Oregon Health and Science University (M.A.S.), Portland, Oregon; DoD Combat Casualty Care Research Program (T.M.P.), US Army Medical Research and Development Command, Fort Detrick, Maryland; Division of Trauma and Acute Care Surgery, Department of Surgery (M.J.M.), Los Angeles County + USC Medical Center, Los Angeles, California; Division of Surgery, Department of Neurosurgery (B.A.J.), University of Arizona School of Medicine, Tucson, Arizona; Department of Neurological Surgery (A.V.), University of Texas Southwestern Medical Center, Dallas, Texas; and American College of Surgeons Committee on Trauma (J.D.K.)., Tadlock MD, Dengler BA, Gavitt BJ, Dirks MS, Holcomb JB, Kotwal RS, Benavides LC, Cannon JW, Edson T, Graybill JC, Sonka BJ, Marion DW, Eckert MJ, Schreiber MA, Polk TM, Jensen SD
Jazyk:	angličtina
Zdroj:	The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2023 Aug 01; Vol. 95 (2S Suppl 1), pp. S7-S12. Date of Electronic Publication: 2023 May 31.
DOI:	10.1097/TA.0000000000004058
Abstrakt:	Background: Experiences over the last three decades of war have demonstrated a high incidence of traumatic brain injury (TBI) resulting in a persistent need for a neurosurgical capability within the deployed theater of operations. Despite this, no doctrinal requirement for a deployed neurosurgical capability exists. Through an iterative process, the Joint Trauma System Committee on Surgical Combat Casualty Care (CoSCCC) developed a position statement to inform medical and nonmedical military leaders about the risks of the lack of a specialized neurosurgical capability. Methods: The need for deployed neurosurgical capability position statement was identified during the spring 2021 CoSCCC meeting. A triservice working group of experienced forward-deployed caregivers developed a preliminary statement. An extensive iterative review process was then conducted to ensure that the intended messaging was clear to senior medical leaders and operational commanders. To provide additional context and a civilian perspective, statement commentaries were solicited from civilian clinical experts including a recently retired military trauma surgeon boarded in neurocritical care, a trauma surgeon instrumental in developing the Brain Injury Guidelines, a practicing neurosurgeon with world-renowned expertise in TBI, and the chair of the Committee on Trauma. Results: After multiple revisions, the position statement was finalized, and approved by the CoSCCC membership in February 2023. Challenges identified include (1) military neurosurgeon attrition, (2) the lack of a doctrinal neurosurgical capabilities requirement during deployed combat operations, and (3) the need for neurosurgical telemedicine capability and in-theater computed tomography scans to triage TBI casualties requiring neurosurgical care. Conclusion: Challenges identified regarding neurosurgical capabilities within the deployed trauma system include military neurosurgeon attrition and the lack of a doctrinal requirement for neurosurgical capability during deployed combat operations. To mitigate risk to the force in a future peer-peer conflict, several evidence-based recommendations are made. The solicited civilian commentaries strengthen these recommendations by putting them into the context of civilian TBI management. This neurosurgical capabilities position statement is intended to be a forcing function and a communication tool to inform operational commanders and military medical leaders on the use of these teams on current and future battlefields. Level of Evidence: Prognostic and Epidemiological; Level V. (Copyright © 2023 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)
Databáze:	MEDLINE
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