title: Admission physiology criteria after injury on the battlefield predict medical resource utilization and patient mortality.
abstract: BACKGROUND
  Medical resources and resource allocation including operating room and blood utilization are of prime importance in the modern combat environment. We hypothesized that easily measurable admission physiologic criteria and injury site as well as injury severity calculated after diagnostic evaluation or surgical intervention, would be strongly correlated with resource utilization and in theater mortality outcomes.
  
  
  METHODS
  We retrospectively reviewed the Joint Theater Trauma Registry for all battlefield casualties presenting to surgical component facilities during Operation Iraqi Freedom from January to July 2004. Data were collected from the composite population of 1,127 battlefield casualty patients with respect to demographics, mechanism, presentation physiology (blood pressure, heart rate, temperature), base deficit, admission hematocrit, Glasgow Coma Score (GCS), Injury Severity Score (ISS), operating room utilization, blood transfusion, and mortality. Univariate and multivariate analyses were conducted to determine the degree to which admission physiology and injury severity correlated with blood utilization, necessity for operation, and acute mortality.
  
  
  RESULTS
  Univariate analysis demonstrated a significant (p < 0.05) association between hypothermia (T < 34 degrees C) and the subsequent requirement for operation and mortality. In addition, the outcome variable total blood product utilization was significantly correlated with base deficit (r = 0.61), admission hematocrit (r = 0.51), temperature (r = 0.47), and ISS (r = 0.54). Using multiple logistic regression techniques, blood pressure, GCS, and ISS together demonstrated a significant association (p < 0.05) with mortality (area under ROC curve = 95%). Multiple linear regression established that blood pressure, heart rate, temperature, hematocrit, and ISS had a collective significant effect (p < 0.05) on total blood product utilization explaining 67% of the variance in this outcome variable.
  
  
  CONCLUSIONS
  Admission physiology and injury characteristics demonstrate a strong capacity to predict resource utilization in the contemporary battlefield environment. In the future, such predictive yield could potentially have significant implications for triage and medical logistics in the resource constrained environment of war and potentially in mass casualty and disaster incidents in the civilian trauma setting which will likely have mechanistic similarity with war related injury.
authors.affiliation: US Army Institute of Surgical Research, San Antonio, TX 78234, USA. brian.eastridge@amedd.army.mil
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Eastridge
authors.forename: Jimmie
authors.initials: J
authors.lastname: Owsley
authors.forename: James
authors.initials: J
authors.lastname: Sebesta
authors.forename: Alec
authors.initials: A
authors.lastname: Beekley
authors.forename: Charles
authors.initials: C
authors.lastname: Wade
authors.forename: Robert
authors.initials: R
authors.lastname: Wildzunas
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: John
authors.initials: J
authors.lastname: Holcomb
mesh_terms: D001794:Blood Pressure; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015600:Glasgow Coma Scale; D006339:Heart Rate; D006772:Hospitals, Military / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D007493:Iraq; D016015:Logistic Models; D008889:Military Personnel; D014857:Warfare; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality / Q000503:physiopathology*