The epidemiology of noncompressible torso hemorrhage in the wars in Iraq and Afghanistan
| Autor: | Todd E. Rasmussen, Jonathan J. Morrison, Adam Stannard, Daniel J. Scott, James D. Ross, Rebecca A Ivatury |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Poison control Hemorrhage Context (language use) Critical Care and Intensive Care Medicine Injury Severity Score Injury prevention Odds Ratio Humans Medicine Registries Military Medicine Iraq War 2003-2011 Retrospective Studies Afghan Campaign 2001 business.industry Incidence Mortality rate Torso Retrospective cohort study Odds ratio Vascular System Injuries Prognosis medicine.disease United States Surgery Military Personnel Anesthesia Pelvic fracture Female business |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 74:830-834 |
| ISSN: | 2163-0755 |
| DOI: | 10.1097/ta.0b013e31827a3704 |
| Popis: | BACKGROUND: Noncompressible torso hemorrhage (NCTH) is the leading cause of potentially survivable trauma in the battlefield and has recently been defined using anatomic and physiologic criteria. The objective of this study was to characterize the frequency and mortality in combat of NCTH using a contemporary definition. METHODS: Four categories of torso injury, each based on vascular disruption, were identified in US military casualties from the Department of Defense Trauma Registry (2002-2010): (1) thoracic, including lung; (2) solid organ (high-grade spleen, liver, and kidney); (3) named axial vessel; and (4) pelvic fracture with ring disruption. Injuries within these categories were evaluated in the context of physiologic indicator of shock and/or the need for operative hemorrhage control. RESULTS: Of 15,209 battle injuries sustained during the study period, 12.7% (n = 1,936) had sustained one or more categories of torso injury. Of these, 331 (17.1%) had evidence of shock or the need for urgent hemorrhage control, with a mean (SD) Injury Severity Score (ISS) and mortality rate of 30 (13) and 18.7%, respectively. Pulmonary injuries were most numerous (41.7%), followed by solid-organ (29.3%), vascular (25.7%), and pelvic (15.1%) injuries. Following multivariate analysis, the most mortal injury complexes were identified as major arterial injury (odds ratio, 3.38; 95% confidence interval, 1.17-9.74) and pulmonary injury (odds ratio, 2.23; 95% confidence interval, 1.23-4.98). CONCLUSION: NCTH can be defined using anatomic parameters combined with physiologic and operative interventions suggestive of hemorrhage. Major arterial and pulmonary injuries contribute most significantly to the mortality burden. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III. Language: en |
| Databáze: | OpenAIRE |
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