Utilizing a Trauma Systems Approach to Benchmark and Improve Combat Casualty Care

Abstract

Background: Derived from the necessity to improve the outcomes of soldiers injured on the battlefield, the U.S. military forces developed and implemented the Joint Theater Trauma System (JTTS) and the Joint Theater Trauma Registry based on U.S. civilian trauma system models. The purpose of this analysis was to develop battlefield injury outcome benchmark metrics and to evaluate the impact of JTTS-driven performance improvement interventions. Methods : To quantify these achievements, the Joint Theater Trauma Registry captured mechanistic, physiologic, diagnostic, therapeutic, and outcome data on 18,377 injured patients from January 2004 to May 2008 for analysis. Benchmarks were developed and statistically validated by using control chart methodology. Results: The majority (66.4%) of battlefield wounds were penetrating mechanism, 23.3% of all patients had an Injury Severity Score of greater than or equal to 16, 21.8% had a base deficit of greater than or equal to 5, 30.5% of patients required blood, and 6.8% required massive transfusion (greater than or equal to 10 units red blood cell per 24 hours). In this severely injured population from the battlefield, the JTTS developed several pertinent benchmark metrics to assess quality of care associated with postinjury complications and mortality. The implementation of 27 JTTS-developed evidenced-based clinical practice guidelines and an improved information dissemination process was associated with a decrease in aggregate postinjury complications by 54%. Conclusions: Despite the numerous challenges of a global trauma system, the JTTS has set the standard for trauma care on the modern battlefield utilizing evidence-based medicine. The development of injury care benchmarks enhanced the evolution of the combat casualty care performance improvement process within the trauma system.

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Document Details

Document Type
Technical Report
Publication Date
Jul 01, 2010
Accession Number
ADA629431

Entities

People

  • Amy Apodaca
  • Brian J. Eastridge
  • Charles E Wade
  • George Costanzo
  • James Dunne
  • John B Holcomb
  • Lorne H Blackbourne
  • Mary A. Spott
  • Stephen Flaherty
  • Susan West

Organizations

  • United States Army Institute of Surgical Research

Tags

DTIC Thesaurus Topics

  • Battlefields
  • Best Practices
  • Blood
  • Blood Cells
  • Blood Transfusions
  • Brain Injuries
  • Casualties
  • Combat Casualty Care
  • Combat Injuries
  • Department Of Defense
  • Department Of Veterans Affairs
  • Law
  • Patient Care
  • Probability Distributions
  • Standards
  • Systems Approach
  • United States

Fields of Study

  • Medicine

Readers

  • Immunology and Pathology
  • Medical or Health Care Field.
  • Organizational Process Management (OPM).