title: 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 > or = 16, 21.8% had a base deficit of > or = 5, 30.5% of patients required blood, and 6.8% required massive transfusion (> or = 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.
authors.affiliation: U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA. brian.eastridge@amedd.army.mil
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Eastridge
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: Mary A
authors.initials: MA
authors.lastname: Spott
authors.forename: George
authors.initials: G
authors.lastname: Costanzo
authors.forename: James
authors.initials: J
authors.lastname: Dunne
authors.forename: Stephen
authors.initials: S
authors.lastname: Flaherty
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Susan
authors.initials: S
authors.lastname: West
authors.forename: Amy
authors.initials: A
authors.lastname: Apodaca
authors.forename: Lorne
authors.initials: L
authors.lastname: Blackbourne
authors.forename: S Ward
authors.initials: SW
authors.lastname: Casscells
mesh_terms: D019985:Benchmarking / Q000458:organization & administration*; D006801:Humans; D008887:Military Medicine / Q000458:organization & administration*; D008889:Military Personnel; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014218:Triage / Q000458:organization & administration; D014481:United States; D014857:Warfare; D014947:Wounds and Injuries / Q000628:therapy*