RESUMEN

BACKGROUND: To report the lengths of key torso vascular and to develop regression models that will predict these lengths, based on an external measure of torso height (EMTH, sternum to pubis) in the development of a fluoroscopy-free balloon occlusion system for hemorrhage control. METHODS: We conducted a prospective, observational study at a Combat Support Hospital in Southern Afghanistan using adult male patients undergoing computed tomography (CT). EMTH was recorded using a tape measure and intra-arterial distance was derived from CT imaging. Regression models to predict distance from the common femoral artery (CFA) into the middle of aortic zone I (left subclavian artery to celiac trunk) and zone III (infrarenal aorta) were developed from a random 20% of the cohort and validated by the remaining 80%. RESULTS: Overall, 177 male patients were included with a median (interquartile range [IQR]) age of 23 (8) years. The median (IQR) lengths of aortic zone I and III were 222 (24), 31 (9), and 92 (15) mm. The mid-zone distance from the left and right CFA to zone I were 423 (27) and 418 (29) and for zone III 232 (21) and 228 (22). Linear regression models demonstrated an accuracy between 99.3% to 100% at predicting the insertion distance required to place a catheter within the middle of each aortic zone. CONCLUSION: This study demonstrates the use of morphometric analysis in the development of a fluoroscopy-free balloon occlusion system for torso hemorrhage control. Further study in a larger population of mixed gender is required to further validate insertion models.

Asunto(s)

Aorta/anatomía & histología , Oclusión con Balón , Técnicas de Apoyo para la Decisión , Hemorragia/terapia , Torso/anatomía & histología , Adolescente , Adulto , Aortografía , Tamaño Corporal , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Tomografía Computarizada por Rayos X , Adulto Joven

RESUMEN

OBJECTIVE: To date, contemporary studies on wartime vascular trauma have focused on acute management strategies and early results, with no characterization of enduring functional limb salvage or its relation to quality of life. The objective of this study was to describe long-term, patient-based quality of life and function after extremity vascular injury (EVI). METHODS: The Joint Theater Trauma Registry was queried for U.S. troops with EVI. Injury and management data was obtained and the Medical Outcomes Study Short Form 36 (SF-36) Health Survey administered after patient contact and consent. Demographic, injury, and management variables were analyzed and examined for correlation with the primary end points of favorable or unfavorable outcome defined by SF-36 Mental (MCS) or Physical Component Summary (PCS) scores of >42 or <42 (effect size ≥ 0.8). RESULTS: Surveys were completed by 214 patients, who were a median age of 25 years (range, 19-52 years). The Injury Severity Score was 15.3 ± 8.6 and the Mangled Extremity Severity Score was 5.65 ± 1.4. Amputation-free survival was 84% at mean follow-up of 61 ± 24 months. Overall SF-36 PCS and MCS scores were 43.0 ± 9.2 and 46.6 ± 12.4, respectively, with 92 respondents (43%) reporting favorable outcomes on both MCS and PCS. On multivariate analysis, older age, severe extremity injury (Mangled Extremity Severity Scores ≥ 7), and chronic pain were predictive of unfavorable physical outcomes (P < .05). Presence of pain, nerve injury, and junior rank (

Asunto(s)

Campaña Afgana 2001- , Extremidades/irrigación sanguínea , Guerra de Irak 2003-2011 , Recuperación del Miembro , Medicina Militar , Evaluación del Resultado de la Atención al Paciente , Calidad de Vida , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular/cirugía , Adulto , Factores de Edad , Distribución de Chi-Cuadrado , Dolor Crónico/etiología , Dolor Crónico/psicología , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Sistema de Registros , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Traumatismos del Sistema Nervioso/etiología , Traumatismos del Sistema Nervioso/psicología , Resultado del Tratamiento , Estados Unidos , Procedimientos Quirúrgicos Vasculares/efectos adversos , Lesiones del Sistema Vascular/complicaciones , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/fisiopatología , Lesiones del Sistema Vascular/psicología , Adulto Joven

RESUMEN

BACKGROUND: Hemorrhage is a leading cause of death in military and civilian trauma. Despite the importance of the aorta as a site of hemorrhage control and resuscitative occlusion, detailed knowledge of its morphometry is lacking. The objective of this study was to characterize aortic morphometry in a trauma population, including quantification of distances as well as and diameters and definition of relevant aortic zones. METHODS: Center line measures were made (Volume Viewer) from contrast computed tomography (CT) scans of male trauma patients (18-45 years). Aortic zones were defined based on branch arteries. Zone I includes left subclavian to celiac; Zone II includes celiac to caudal renal; Zone III includes caudal renal to aortic bifurcation. Zone lengths were calculated and correlated to a novel external measure of torso extent (symphysis pubis to sternal notch). RESULTS: Eighty-eight males (mean [SD], 28 [4] years) had CT scans for the study. The median (interquartile range) lengths (mm) of Zones I, II, and III were 210 mm (202-223 mm), 33 mm (28-38 mm), and 97 mm (91-103 mm), respectively. Median aortic diameters at the left subclavian, celiac, and lowest renal arteries were 21 mm (20-23 mm), 18 mm (16-19 mm), and 15 mm (14-16 mm), respectively, and the terminal aortic diameter was 14 mm (13-15 mm). The correlation of determination for descending aortic length (all zones) against torso extend was r = 0.454. CONCLUSION: This study provides a morphometric analysis of the aorta in a male population, demonstrating consistency of length and diameter while defining distinct axial zones. Findings suggest that center line aortic distances correlate with a simple, external measure of torso extent. Morphometric study of the aorta using CT data may facilitate the development and implementation of occlusion techniques to manage noncompressible torso, pelvic, and junctional femoral hemorrhage.

Asunto(s)

Aorta/anatomía & histología , Arterias/anatomía & histología , Resucitación , Torso/irrigación sanguínea , Adolescente , Adulto , Arteria Celíaca/anatomía & histología , Técnicas Hemostáticas , Humanos , Masculino , Persona de Mediana Edad , Resucitación/métodos , Arteria Subclavia/anatomía & histología , Tomografía Computarizada por Rayos X , Heridas y Lesiones/patología , Heridas y Lesiones/terapia , Adulto Joven

RESUMEN

BACKGROUND: Hemorrhage following traumatic injury is a leading cause of military and civilian mortality. Noncompressible torso hemorrhage (NCTH) has been identified as particularly lethal, especially in the prehospital setting. METHODS: All patients sustaining NCTH between August 2002 and July 2012 were identified from the UK Joint Theatre Trauma Registry. NCTH was defined as injury to a named torso axial vessel, pulmonary injury, solid-organ injury (Grade 4 or greater injury to the liver, kidney, or spleen) or pelvic fracture with ring disruption. Patients with ongoing hemorrhage were identified using either a systolic blood pressure of less than 90 mm Hg or the need for immediate surgical hemorrhage control. Data on injury pattern and location as well as cause of death were analyzed using univariate and multivariate analyses. RESULTS: During 10 years, 296 patients were identified with NCTH, with a mortality of 85.5%. The majority of deaths occurred before hospital admission (n = 222, 75.0%). Of patients admitted to hospital, survivors (n = 43, 14.5%) had a higher median systolic blood pressure (108 [43] vs. 89 [46], p = 0.123) and Glasgow Coma Scale (GCS) (14 [12] vs. 3 [0], p < 0.001) compared with in-hospital deaths (n = 31, 10.5%). Hemorrhage was the more common cause of death (60.1%), followed by central nervous system disruption (30.8%), total body disruption (5.1%), and multiple-organ failure (4.0%). On multivariate analysis, major arterial and pulmonary hilar injury are most lethal with odds ratio (95% confidence interval) of 16.44 (5.50-49.11) and 9.61 (1.06-87.00), respectively. CONCLUSION: This study demonstrates that the majority of patients sustaining NCTH die before hospital admission, with exsanguination and central nervous system disruption contributing to the bulk cause of death. Major arterial and pulmonary hilar injuries are independent predictors of mortality.

Asunto(s)

Exsanguinación/mortalidad , Medicina Militar/estadística & datos numéricos , Traumatismos Torácicos/mortalidad , Adulto , Campaña Afgana 2001- , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Guerra de Irak 2003-2011 , Masculino , Sistema de Registros , Estudios Retrospectivos , Reino Unido , Adulto Joven

RESUMEN

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.

Asunto(s)

Hemorragia/epidemiología , Medicina Militar/estadística & datos numéricos , Personal Militar , Sistema de Registros , Torso/irrigación sanguínea , Lesiones del Sistema Vascular/complicaciones , Adulto , Campaña Afgana 2001- , Femenino , Hemorragia/diagnóstico , Hemorragia/etiología , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Guerra de Irak 2003-2011 , Masculino , Oportunidad Relativa , Pronóstico , Estudios Retrospectivos , Torso/lesiones , Estados Unidos/epidemiología , Lesiones del Sistema Vascular/epidemiología

Asunto(s)

Medicina Militar/organización & administración , Lesiones del Sistema Vascular/cirugía , Campaña Afgana 2001- , Traumatismos del Brazo/cirugía , Investigación Biomédica/métodos , Investigación Biomédica/organización & administración , Conducta Cooperativa , Humanos , Guerra de Irak 2003-2011 , Traumatismos de la Pierna/cirugía , Medicina Militar/métodos , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/organización & administración , Sistema de Registros

Asunto(s)

Aorta Torácica , Oclusión con Balón/métodos , Resucitación/métodos , Choque Hemorrágico/mortalidad , Choque Hemorrágico/terapia , Terapia Combinada , Enfermedad Crítica/mortalidad , Enfermedad Crítica/terapia , Tratamiento de Urgencia/métodos , Femenino , Humanos , Masculino , Pronóstico , Medición de Riesgo , Choque Hemorrágico/diagnóstico , Análisis de Supervivencia , Resultado del Tratamiento

RESUMEN

BACKGROUND: The optimal method of vascular control and resuscitation in patients with life-threatening, extrathoracic torso hemorrhage remains debated. Guidelines recommend emergency department thoracotomy (EDT) with aortic clamping, although transabdominal aortic clamping followed by vascular control and direct vascular control (DVC) without aortic clamping are alternatives. The objective of this study is to compare the effectiveness of three approaches to extrathoracic torso hemorrhage in a large animal model. METHODS: Adolescent swine (Sus Scrofa) (mean weight = 80.9 kg) were randomized into three groups all of which had class IV shock established by hemorrhage from an iliac artery injury. Group 1: EDT with thoracic aortic clamping (N = 6); group 2: transabdominal supraceliac aortic clamping (SCC; N = 6); and group 3: DVC of bleeding site without aortic clamping (N = 6). After hemorrhage, EDT or SCC was performed in groups 1 and 2, respectively, with subsequent exploration of the bleeding site and placement of a temporary vascular shunt (TVS). Group 3 (DVC) underwent direct exploration of the injury and placement of a TVS. All groups were resuscitated to predefined physiologic endpoints over 6 hours with repeated measures of central and cerebral perfusion and end-organ function at standardized time points. Postmortem tissue analysis was performed to quantify injury to critical tissue beds. RESULTS: There was no difference in mortality among the groups and no TVS failures. Central aortic pressure, carotid flow, and partial pressure brain tissue oximetry, all demonstrated increases in EDT and SCC after application of the aortic clamp relative to DVC (p < 0.05). During resuscitation, serum lactate levels were higher in EDT compared with SCC and DVC (6.85 vs. 3.08 and 2.15, respectively; p < 0.05) and serum pH in EDT reflected greater acidosis than SCC and DVC (7.24 vs. 7.36 and 7.39, respectively; p < 0.05). EDT and SCC required more intravenous fluid than DVC (2,166 mL and 2,166 mL vs. 667 mL, respectively; p < 0.05) and more vasopressors were used in EDT and SCC compared with DVC (52.1 µg and 43.5 µg vs. 12.4 µg, respectively; p < 0.05). Brain and myocardial tissue stains demonstrated the same degree of acute ischemic changes in all groups. CONCLUSION: Although aortic clamping increases central and cerebral perfusion, DVC results in less physiologic derangement. The optimal method of aortic control would incorporate the benefits of maintained central pressure with less associated morbidity. Clinical studies evaluating DVC are warranted.

Asunto(s)

Aorta Torácica/lesiones , Arteria Ilíaca/lesiones , Choque Hemorrágico/fisiopatología , Choque Hemorrágico/terapia , Heridas y Lesiones/fisiopatología , Heridas y Lesiones/terapia , Animales , Modelos Animales de Enfermedad , Lactatos/sangre , Monitoreo Fisiológico , Oxígeno/sangre , Estudios Prospectivos , Distribución Aleatoria , Resucitación , Instrumentos Quirúrgicos , Porcinos

RESUMEN

BACKGROUND: Noncompressible torso hemorrhage is the leading cause of potentially preventable death on the modern battlefield. The objective of this study is to characterize resuscitative aortic balloon occlusion (BO) compared to thoracotomy with aortic clamping in a model of hemorrhagic shock. METHODS: A total of 18 swine (3 groups; 6 animals/group) were used in this study. Swine in class IV shock underwent no aortic occlusion (NO), thoracotomy and clamp occlusion (CO), or endovascular BO. Animals in the NO group underwent direct placement of a temporary vascular shunt (TVS) at the injury site, whereas animals in the CO and BO groups underwent aortic occlusion before TVS placement. Hemodynamic and physiologic measures were collected. RESULTS: The central aortic pressure, carotid blood flow and brain oxygenation as measured by oximetry increased in the CO and BO groups compared to the NO group (P < .05). During resuscitation, the BO group was less acidotic than the CO group (pH,7.35 vs 7.24; P < .05) with a lower serum lactate level (4.27 vs 6.55; P < .05) and pCO2 level (43.5 vs 49.9; P < .05). During resuscitation, the BO group required less fluid (667 mL vs 2,166 mL; P < .05) and norepinephrine (0 mcg vs 52.1 mcg; P < .05) than the CO group. CONCLUSION: Resuscitative aortic BO increases central perfusion pressures with less physiologic disturbance than thoracotomy with aortic clamping in a model of hemorrhagic shock. Endovascular BO of the aorta should be explored further as an option in the management of noncompressible torso hemorrhage.

Asunto(s)

Aorta Torácica , Oclusión con Balón/métodos , Choque Hemorrágico/mortalidad , Choque Hemorrágico/terapia , Toracotomía/métodos , Animales , Oclusión con Balón/mortalidad , Constricción , Modelos Animales de Enfermedad , Femenino , Distribución Aleatoria , Resucitación/métodos , Resucitación/mortalidad , Medición de Riesgo , Choque Hemorrágico/cirugía , Tasa de Supervivencia , Porcinos , Toracotomía/mortalidad , Resultado del Tratamiento

RESUMEN

Surgeons working within the United Kingdom's National Health Service have an established history of clinical innovation, research, and development in the field of vascular surgery but lack a unified trauma system to deliver optimal care for patients with vascular injury. The low incidence of vascular trauma, combined with lack of regional trauma systems, works against optimal delivery of care to the polytrauma patient. Providing care, robust data capture, and opportunities for training and education in vascular injury lag behind other elective domains of vascular practice. The challenge is to define ideal care pathways, referral networks, and standards of practice and to integrate the care of such patients. In 2010, a trauma system for London was introduced; it has provided vascular surgeons with a unique opportunity to study and advance the care of patients with vascular injury. This article discusses developing trauma network issues, particularly the organization and evolution of vascular trauma services in the United Kingdom.

Asunto(s)

Prestación Integrada de Atención de Salud , Centros Traumatológicos , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular/cirugía , Certificación , Competencia Clínica , Prestación Integrada de Atención de Salud/historia , Prestación Integrada de Atención de Salud/organización & administración , Educación de Postgrado en Medicina , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Centros Traumatológicos/historia , Centros Traumatológicos/organización & administración , Reino Unido , Procedimientos Quirúrgicos Vasculares/educación , Procedimientos Quirúrgicos Vasculares/historia , Procedimientos Quirúrgicos Vasculares/organización & administración , Lesiones del Sistema Vascular/epidemiología , Lesiones del Sistema Vascular/historia

RESUMEN

BACKGROUND: Noncompressible hemorrhage from central vascular injuries remains the leading cause of preventable death in modern combat. This report introduces a large animal model of noncompressible torso hemorrhage, which permits assessment of the various approaches to this problem. METHODS: Yorkshire swine were anesthetized and monitoring devices for central aortic pressure, carotid flow, and intracerebral and transcutaneous brain oximetry were applied. Class IV hemorrhagic shock was induced through an iliac arterial injury and animals were subjected to different vascular control methods including thoracic aortic clamping, supraceliac aortic clamping, direct vascular control, and proximal endovascular balloon occlusion. After vascular control, the injury was shunted, and damage control resuscitation was continued. Serum markers, intravenous fluid volumes, and vasopressor requirements were tracked over a subsequent resuscitation period. Postmortem tissue analysis was performed to compare levels of acute ischemic injury between groups. RESULTS: The protocol for animal preparation, hemorrhage volume, open surgical technique, and posthemorrhage resuscitation was developed using four animals. The endovascular approach was developed using two additional animals. After model development, treatment animals subsequently underwent noncompressible hemorrhage with thoracic aortic clamping, supraceliac aortic clamping, direct vascular control, and endovascular aortic occlusion. Premature death occurred in one animal in the direct vascular control group. CONCLUSION: This study presents a large animal model of class IV hemorrhagic shock from noncompressible hemorrhage, which permits comparison of various vascular control methods to address this challenging problem. Future studies using this model as the standard will allow further development of strategies for the management of noncompressible hemorrhage.

Asunto(s)

Modelos Animales de Enfermedad , Hemorragia/terapia , Heridas y Lesiones/terapia , Animales , Aorta Torácica/lesiones , Oclusión con Balón , Monitoreo de Gas Sanguíneo Transcutáneo , Hemorragia/etiología , Hemorragia/cirugía , Hipoxia Encefálica/sangre , Monitoreo Fisiológico , Oxígeno/sangre , Presión Parcial , Instrumentos Quirúrgicos , Porcinos , Heridas y Lesiones/etiología , Heridas y Lesiones/cirugía

RESUMEN

BACKGROUND: Blood vessel trauma leading to hemorrhage or ischemia presents a significant cause of morbidity and mortality after battlefield injury. The objective of this study is to characterize the epidemiology of vascular injury in the wars of Iraq and Afghanistan, including categorization of anatomic patterns, mechanism, and management of casualties. METHODS: The Joint Theater Trauma Registry was interrogated (2002-2009) for vascular injury in US troops to identify specific injury (group 1) and operative intervention (group 2) groups. Battle-related injuries (nonreturn to duty) were used as the denominator to establish injury rates. Mechanism of injury was compared between theaters of war and the management strategies of ligation versus revascularization (repair and interposition grafting) reported. RESULTS: Group 1 included 1570 Troops injured in Iraq (OIF) (n = 1390) and Afghanistan (OEF) (n = 180). Mechanism included explosive (73%), gunshot (27%), and other (<1%) with explosive more common in OIF than OEF (P < 0.05). During this period, 13,076 battle-related injuries occurred resulting in a specific rate of 12% (1570 of 13,076), which was higher in OIF than OEF (12.5% vs 9% respectively; P < 0.05). Of group 1, 60% (n = 940) sustained injury to major or proximal vessels and 40% (n = 630) to minor or distal vessels (unknown vessel, n = 27). Group 2 (operative) comprised 1212 troops defining an operative rate of 9% (1212 of 13,076) and included ligation (n = 660; 54%) or repair (n = 552; 46%). Peak rates in OIF and OEF occurred in November 2004 (15%) and August 2009 (11%), respectively and correlated with combat operational tempo. CONCLUSION: The rate of vascular injury in modern combat is 5 times that reported in previous wars and varies according to theater of war, mechanism of injury and operational tempo. Methods of reconstruction are now applied to nearly half of the vascular injuries and should be a focus of training for combat surgery. Selective ligation of vascular injury remains an important management strategy, especially for minor or distal vessel injuries.

Asunto(s)

Lesiones del Sistema Vascular/epidemiología , Lesiones del Sistema Vascular/cirugía , Guerra , Campaña Afgana 2001- , Afganistán , Implantación de Prótesis Vascular , Vasos Sanguíneos/lesiones , Humanos , Irak , Guerra de Irak 2003-2011 , Ligadura , Medicina Militar , Sistema de Registros

RESUMEN

BACKGROUND: In order to advance beyond basic statistical limb salvage to improved functional or quality limb salvage, a better understanding of the ischemic threshold of the limb is required. To date, models of extremity ischemia and reperfusion involve small animals and few include survival with physiologic measures of nerve and muscle recovery. In addition, the effect of hemorrhagic shock on the ischemic threshold of the extremity is unknown. This study characterized the effect of class III hemorrhagic shock on the ischemic threshold of the extremity in a large-animal model of neuromuscular recovery. METHODS: Yorkshire/Landrace-cross swine (weight, 70-90 kg) were randomized to iliac artery repair either immediately or at 1, 3, or 6 hours after vessel loop occlusion and arteriotomy. A fifth group underwent excision of the arterial segment without repair to represent ligation. Class III shock was created by removing 35% of total blood volume using a variable rate model. Animals were monitored for 14 days to serially collect markers of functional recovery. RESULTS: Animals with ≤1 hour ischemia (control) had clinically normal limb function by the end of the 2-week observation period, with minimal muscle and nerve changes on histology. Separate analysis of contralateral, nonexperimental limbs revealed normal histology and function. After 3 hours of ischemia, functional recovery was impaired, with moderate-to-severe degeneration of nerve and muscle noted on histology. Animals undergoing 6 hours of ischemia or ligation had minimal electromyelography response and severe systemic inflammation, which correlated with severe muscle and nerve degeneration. Concurrent class III hemorrhagic shock was associated with a decrement in neuromuscular recovery across all groups but was greatest in groups undergoing ≥3 hours of extremity ischemia (P < .01). CONCLUSIONS: This study demonstrates the feasibility of combined hemorrhagic shock and extremity ischemia-reperfusion in a large-animal survival model. The presence of hemorrhagic shock compounds the effect of extremity ischemia, reducing the ischemic threshold of the limb to <3 hours. Strategies to improve functional salvage after extremity vascular injury in the setting of shock should include attempts at restoration of flow ≤60 minutes.

Asunto(s)

Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/inervación , Enfermedades Musculares/etiología , Degeneración Nerviosa/etiología , Daño por Reperfusión/complicaciones , Choque Hemorrágico/complicaciones , Lesiones del Sistema Vascular/complicaciones , Animales , Biomarcadores/sangre , Modelos Animales de Enfermedad , Electromiografía , Femenino , Marcha , Miembro Posterior , Músculo Esquelético/patología , Enfermedades Musculares/sangre , Enfermedades Musculares/patología , Enfermedades Musculares/fisiopatología , Degeneración Nerviosa/sangre , Degeneración Nerviosa/patología , Degeneración Nerviosa/fisiopatología , Conducción Nerviosa , Examen Neurológico , Postura , Recuperación de la Función , Flujo Sanguíneo Regional , Daño por Reperfusión/sangre , Daño por Reperfusión/patología , Daño por Reperfusión/fisiopatología , Choque Hemorrágico/sangre , Choque Hemorrágico/patología , Choque Hemorrágico/fisiopatología , Sus scrofa , Factores de Tiempo , Lesiones del Sistema Vascular/sangre , Lesiones del Sistema Vascular/patología , Lesiones del Sistema Vascular/fisiopatología

RESUMEN

BACKGROUND: Key performance indicators (KPI) are tools for assessing process and outcome in systems of health care provision and are an essential component in performance improvement. Although KPI have been used in British military trauma for 10 years, they remain poorly defined and are derived from civilian metrics that do not adjust for the realities of field trauma care. Our aim was to modify current trauma KPI to ensure they more faithfully reflect both the military setting and contemporary evidence in order to both aid accurate calibration of the performance of the British Defence Medical Services and act as a driver for performance improvement. METHOD: A workshop was convened that was attended by senior, experienced doctors and nurses from all disciplines of trauma care in the British military. "Speciality-specific" KPI were developed by interest groups using evidence-based data where available and collective experience where this was lacking. In a final discussion these were streamlined into 60 KPI covering each phase of trauma management. CONCLUSION: The introduction of these KPI sets a number of important benchmarks by which British military trauma can be measured. As part of a performance improvement programme, these will allow closer monitoring of our performance and assist efforts to develop, train, and resource British military trauma providers.

Asunto(s)

Medicina Militar/normas , Personal Militar , Evaluación de Procesos y Resultados en Atención de Salud , Indicadores de Calidad de la Atención de Salud , Traumatología/normas , Heridas y Lesiones/terapia , Humanos , Reino Unido/epidemiología , Heridas y Lesiones/epidemiología