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首页> 外文期刊>Military Medical Research >Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations: a retrospective study
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Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations: a retrospective study

机译:回顾性研究:院前医疗后送(MEDEVAC)运输时间对非压缩性躯干损伤和截肢患者的战斗死亡率的影响

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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 non-compressible 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 modeling. Results 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 trend. Conclusions 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 and outcomes was found in patients who did not sustain NCTI. Priority for rapid evacuation of combat casualties should be given to those with NCTI.
机译:背景技术在作战行动中,遭受外伤的患者需要迅速撤离以提高生存率。研究表明,较长的运输时间会增加发病率和死亡率。关于运输时间对特定损伤类型的患者预后的影响,存在有限的数据。这项研究的目的是确定从最初的医疗后送请求到到达医疗机构这段时间对创伤性肢体截肢和不可压缩的躯干损伤(NCTI)伤亡的发病率和死亡率的影响。方法我们对2011年1月至2014年3月在“持久自由行动”中遭受外伤性截肢和NCTI的美国军人的MEDEVAC患者护理记录进行了回顾性回顾。我们将患者分为外伤性截肢和NCTI(AMP + NCTI),仅包括外伤性截肢(AMP),而AMP和NCTI(Non-AMP / NCTI)都没有。使用卡方检验,Fisher精确检验,Cochran-Armitage趋势检验,Shapiro-Wilks检验,Wilcoxon和Kruskal-Wallis技术以及Cox比例风险回归建模进行分析。结果我们审查了1267条记录,其中669条的损伤严重程度评分(ISS)为10或更高,并包括在分析中。在研究人群中,只有15.5%的截肢受伤(n = 104,仅AMP),10.8%的截肢和NCTI(n = 72,AMP + NCTI),以及73.7%的没有截肢或NCTI(n = 493,非AMP / NCTI)。 AMP + NCTI的死亡率最高(16.7%),运输时间超过60分钟。尽管AMP + NCTI组的生存期随着运输时间的延长而降低,但AMP和Non-AMP / NCTI并没有表现出相同的趋势。结论截肢损伤和NCTI合并症患者从受伤点到医疗机构的运输时间缩短与死亡率降低相关。在未维持NCTI的患者中,转运时间与预后之间无显着关联。快速撤离战斗伤亡的人员应优先考虑NCTI人员。

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